Jun J Yang,Samuel J Mullan,Tahmid M Rayhan,Ciaran K S S Sandhu,Anshu N Ramaiya,Carl J Heneghan
BACKGROUNDRisk assessment plays an important role in surgical decision-making. To estimate complication risk, many surgeons rely on gestalt, a mental process that involves integrating a range of clinical information. Others utilize dedicated risk scoring tools, which offer more standardized assessments. The aims of this systematic review were to explore the current evidence on the predictive value of gestalt for adverse postoperative events and to compare gestalt prediction with various scoring tools.METHODSThis systematic review was conducted following the PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. MEDLINE, Embase, Scopus, ClinicalTrials.gov, ACM digital library, and IEEE Xplore databases were searched. Studies concerned with surgeon gestalt prediction of adverse postoperative outcomes were included. Risk of bias was assessed using the QUADAS-2 tool. Outcomes evaluated were gestalt and scoring tool predictive accuracies for mortality and morbidity. A narrative synthesis was conducted.RESULTSA total of 34 studies encompassing 33 657 patients were included. Surgeons had good discrimination when predicting mortality, but consistently overestimated risk. Scoring tools generally outperformed surgeons, but integrated tools incorporating both gestalt and scoring tool outputs performed best. There was some evidence that gestalt accuracy improved with surgeon experience. Surgeons may also be better at predicting complications for elective procedures compared with emergency procedures.CONCLUSIONSurgeon gestalt can be a valuable predictor of surgical outcomes both on its own and as a component of integrated risk scoring tools. Future studies should aim to elucidate what factors contribute to effective gestalt assessment.
{"title":"Predictive accuracy of surgeon gestalt for adverse postoperative outcomes: systematic review.","authors":"Jun J Yang,Samuel J Mullan,Tahmid M Rayhan,Ciaran K S S Sandhu,Anshu N Ramaiya,Carl J Heneghan","doi":"10.1093/bjs/znaf249","DOIUrl":"https://doi.org/10.1093/bjs/znaf249","url":null,"abstract":"BACKGROUNDRisk assessment plays an important role in surgical decision-making. To estimate complication risk, many surgeons rely on gestalt, a mental process that involves integrating a range of clinical information. Others utilize dedicated risk scoring tools, which offer more standardized assessments. The aims of this systematic review were to explore the current evidence on the predictive value of gestalt for adverse postoperative events and to compare gestalt prediction with various scoring tools.METHODSThis systematic review was conducted following the PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. MEDLINE, Embase, Scopus, ClinicalTrials.gov, ACM digital library, and IEEE Xplore databases were searched. Studies concerned with surgeon gestalt prediction of adverse postoperative outcomes were included. Risk of bias was assessed using the QUADAS-2 tool. Outcomes evaluated were gestalt and scoring tool predictive accuracies for mortality and morbidity. A narrative synthesis was conducted.RESULTSA total of 34 studies encompassing 33 657 patients were included. Surgeons had good discrimination when predicting mortality, but consistently overestimated risk. Scoring tools generally outperformed surgeons, but integrated tools incorporating both gestalt and scoring tool outputs performed best. There was some evidence that gestalt accuracy improved with surgeon experience. Surgeons may also be better at predicting complications for elective procedures compared with emergency procedures.CONCLUSIONSurgeon gestalt can be a valuable predictor of surgical outcomes both on its own and as a component of integrated risk scoring tools. Future studies should aim to elucidate what factors contribute to effective gestalt assessment.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"196 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613357","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}
Linda Adwall,Irma Fredriksson,Hella Hultin,Peter Stålberg,Maria Mani,Olov Norlén,Helena Sackey
BACKGROUNDPostoperative infections are well-known complications following cancer surgery and are associated with worse oncological outcomes in several cancer types. The influence of major systemic postoperative infections on the risk of breast cancer recurrence remains unexplored. The primary aim of this study was to assess the risk of distant recurrence following major systemic infection. Secondary aims were to assess this risk after other major events such as stroke, myocardial infarction and pulmonary embolism.METHODSThis nationwide cohort study included patients who underwent breast cancer surgery in Sweden between 2008 and 2019. The study cohort was identified using BCBaSe 3.0, a database linking the Swedish National Breast Cancer Quality Register with other national population-based healthcare registers. The primary exposure was major systemic infection within 90 days of surgery, with a secondary analysis of other major events. The primary outcome was distant recurrence, whereas secondary outcomes included locoregional recurrence, overall survival, and breast cancer-specific survival.RESULTSAmong 82 102 patients included, 1.8% (n = 1461) experienced a major systemic infection, and 0.6% (n = 516) other major events within 90 days of surgery. In adjusted analyses, major systemic infection was associated with increased risk of distant recurrence (HR 1.23, 95% c.i. 1.07-1.41), overall death (HR 1.47, 1.32-1.64), breast cancer-specific death (HR 1.27, 1.06-1.51), but not with locoregional recurrence.CONCLUSIONSAt a median follow-up of 4.8 years, major systemic postoperative infections were associated with an increased risk of distant recurrence, overall death, and breast cancer-specific death, highlighting the importance of timely and effective treatment of postoperative infections.
{"title":"Major systemic infection following breast cancer surgery and oncological outcomes.","authors":"Linda Adwall,Irma Fredriksson,Hella Hultin,Peter Stålberg,Maria Mani,Olov Norlén,Helena Sackey","doi":"10.1093/bjs/znaf233","DOIUrl":"https://doi.org/10.1093/bjs/znaf233","url":null,"abstract":"BACKGROUNDPostoperative infections are well-known complications following cancer surgery and are associated with worse oncological outcomes in several cancer types. The influence of major systemic postoperative infections on the risk of breast cancer recurrence remains unexplored. The primary aim of this study was to assess the risk of distant recurrence following major systemic infection. Secondary aims were to assess this risk after other major events such as stroke, myocardial infarction and pulmonary embolism.METHODSThis nationwide cohort study included patients who underwent breast cancer surgery in Sweden between 2008 and 2019. The study cohort was identified using BCBaSe 3.0, a database linking the Swedish National Breast Cancer Quality Register with other national population-based healthcare registers. The primary exposure was major systemic infection within 90 days of surgery, with a secondary analysis of other major events. The primary outcome was distant recurrence, whereas secondary outcomes included locoregional recurrence, overall survival, and breast cancer-specific survival.RESULTSAmong 82 102 patients included, 1.8% (n = 1461) experienced a major systemic infection, and 0.6% (n = 516) other major events within 90 days of surgery. In adjusted analyses, major systemic infection was associated with increased risk of distant recurrence (HR 1.23, 95% c.i. 1.07-1.41), overall death (HR 1.47, 1.32-1.64), breast cancer-specific death (HR 1.27, 1.06-1.51), but not with locoregional recurrence.CONCLUSIONSAt a median follow-up of 4.8 years, major systemic postoperative infections were associated with an increased risk of distant recurrence, overall death, and breast cancer-specific death, highlighting the importance of timely and effective treatment of postoperative infections.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"6 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656825","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}
BACKGROUNDMagnetic seeds have comparable performance to guidewires in breast lesion localization with the advantages of shorter operating time, facilitated logistics, and higher staff satisfaction. However, the high cost of the device remains a concern and warrants health economic evaluation.METHODSThis is a predefined health economic analysis of a pragmatic RCT including 426 patients (median age of 65 (interquartile range (i.q.r.) 56-71) years, median BMI of 26.6 (i.q.r. 24.0-29.8) kg/m2, and a median tumour size of 11 (i.q.r. 8-15) mm) with non-palpable breast cancer, randomized to localization of the tumour with either a magnetic seed or a guidewire. Sentinel lymph node detection was performed using superparamagnetic iron oxide nanoparticles, enabling a totally magnetic approach. A cost-minimization analysis was conducted, from a healthcare system perspective, using unadjusted and adjusted analyses of costs.RESULTSThe unadjusted analysis did not show any difference in incremental costs (guidewire €3337 versus magnetic seed €3274; difference -€63 (95% c.i. -€302 to €174); P = 0.599). The adjusted analysis, including marker, type of breast surgery performed, and single-session lesion and SLN localization, showed that the magnetic seed was associated with reduced costs (guidewire €3514 versus magnetic seed €3123; difference -€391 (95% c.i. -€422 to -€360); P = 0.002), corresponding to a 11.1% reduction. Sensitivity analyses did not change direction of outcome.CONCLUSIONIn this predefined health economic analysis of an RCT, the use of magnetic seeds resulted in incremental cost containment, despite the increased cost of the device. Contributing factors included shorter localization time, shorter operating time, and process streamlining.
背景磁种子在乳腺病变定位方面的效果与导丝相当，具有手术时间短、物流方便、工作人员满意度高等优点。然而，该设备的高成本仍然是一个问题，需要进行健康经济评估。方法：对一项包括426例患者（中位年龄65岁，四分位数间距（i.qr））的实用随机对照试验进行预先确定的健康经济分析。56-71)岁，中位BMI为26.6 (i.q.r为24.0-29.8)kg/m2，中位肿瘤大小为11 (i.q.r为8-15)mm，伴有不可触及的乳腺癌，随机分配到肿瘤定位，使用磁性种子或导丝。使用超顺磁性氧化铁纳米颗粒进行前哨淋巴结检测，实现全磁性方法。从医疗保健系统的角度，使用未调整和调整的成本分析进行了成本最小化分析。结果：未经调整的分析没有显示增量成本有任何差异(导丝3337欧元与磁种子3274欧元，差异63欧元（95% c - i - 302欧元至174欧元）；P = 0.599)。调整后的分析，包括标记物、乳房手术类型、单期病变和SLN定位，显示磁性种子与降低成本相关(导丝3514欧元，磁性种子3123欧元；差异391欧元（95% c - 422欧元至360欧元）；P = 0.002)，相当于减少了11.1%。敏感性分析没有改变结果的方向。结论：在一项随机对照试验的预先健康经济分析中，尽管设备成本增加，但磁性种子的使用导致了成本控制的增加。促成因素包括更短的本地化时间、更短的操作时间和流程简化。
{"title":"Magnetic seed versus guidewire-based breast cancer localization with magnetic lymph node detection: cost-minimization analysis.","authors":"Eirini Pantiora,Filipa Sampaio,Allan Jazrawi,Fredrik Wärnberg,Staffan Eriksson,Andreas Karakatsanis","doi":"10.1093/bjs/znaf253","DOIUrl":"https://doi.org/10.1093/bjs/znaf253","url":null,"abstract":"BACKGROUNDMagnetic seeds have comparable performance to guidewires in breast lesion localization with the advantages of shorter operating time, facilitated logistics, and higher staff satisfaction. However, the high cost of the device remains a concern and warrants health economic evaluation.METHODSThis is a predefined health economic analysis of a pragmatic RCT including 426 patients (median age of 65 (interquartile range (i.q.r.) 56-71) years, median BMI of 26.6 (i.q.r. 24.0-29.8) kg/m2, and a median tumour size of 11 (i.q.r. 8-15) mm) with non-palpable breast cancer, randomized to localization of the tumour with either a magnetic seed or a guidewire. Sentinel lymph node detection was performed using superparamagnetic iron oxide nanoparticles, enabling a totally magnetic approach. A cost-minimization analysis was conducted, from a healthcare system perspective, using unadjusted and adjusted analyses of costs.RESULTSThe unadjusted analysis did not show any difference in incremental costs (guidewire €3337 versus magnetic seed €3274; difference -€63 (95% c.i. -€302 to €174); P = 0.599). The adjusted analysis, including marker, type of breast surgery performed, and single-session lesion and SLN localization, showed that the magnetic seed was associated with reduced costs (guidewire €3514 versus magnetic seed €3123; difference -€391 (95% c.i. -€422 to -€360); P = 0.002), corresponding to a 11.1% reduction. Sensitivity analyses did not change direction of outcome.CONCLUSIONIn this predefined health economic analysis of an RCT, the use of magnetic seeds resulted in incremental cost containment, despite the increased cost of the device. Contributing factors included shorter localization time, shorter operating time, and process streamlining.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"32 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645016","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}
Tobias Hauge,Aram Abu Hejleh,Alberto Aiolfi,Felix Berlth,Luigi Bonavina,Linda Brake,Lena-Christin Conradi,Xavier Benoit D'Journo,David Edholm,Jessie Elliot,Wietse Eshuis,Nora Friedrich,Suzanne Gisbertz,Peter Grimminger,Christian Alexander Gutschow,Shantanu Joglekar,Bastiaan Klarenbeek,Fredrik Klevebro,Cezanne D Kooij,Misha Luyer,Alfio Milazzo,Lucia Moletta,Johnny Moons,Krishna Moorthy,Beat P Müller-Stich,Henrik Nienhüser,Philippe Nafteux,Giulia Nezi,Raphael Nico,Kerstin J Neuschütz,Grard Nieuwenhuijzen,Nicola Raftery,Franziska Renger,Ioannis Rouvelas,Jelle P Ruurda,Marcel A Schneider,Daniela Polette Stubb,Alban Todesco,Michele Valmasoni,Mark I van Berge Henegouwen,Elke van Daele,Richard van Hillegersberg,Sander J M van Hootegem,Hanne Vanommeslaeghe,Julie Veziant,Bas Wijnhoven,João Pedro Vilela,Christiane J Bruns,Magnus Nilsson,Wolfgang Schröder
BACKGROUNDBoerhaave syndrome is defined as a spontaneous perforation of the oesophagus. The mainstay of treatment is resuscitation of the patient, closure of the oesophageal defect, and drainage of perioesophageal and pleural fluid collections. Whether the optimal approach is endoscopic, surgical, or conservative management remains unknown and there are no clear guidelines. The aim of this multicentre retrospective cohort study was to evaluate current treatment strategies and outcomes for Boerhaave syndrome.METHODSA multicentre retrospective analysis of data from 23 participating European tertiary centres was performed. Patients with Boerhaave syndrome treated between January 2019 and December 2023 were eligible for inclusion. The primary endpoint was the length of ICU stay and secondary endpoints included in-hospital mortality, 90-day mortality, and the length of overall hospital stay.RESULTSIn total, 216 patients were included; 151 were men (70%), the median age was 62 (22-95) years, and 81 (40%) were treated >24 h after the start of symptoms. Seventy (32%) patients were managed endoscopically (group I), 73 (34%) were managed surgically (group II), 67 (31%) were managed using a combination of endoscopy and surgery (group III), and 6 (3%) were managed using other methods (group IV). For patients in groups I-III: the median length of ICU stay was 8 (0-67) days, with no differences between the three groups (P = 0.105); the in-hospital mortality rate and 90-day mortality rate were both 12% (P = 0.490 and P = 0.637, respectively); and the median length of overall hospital stay was 27 (range 1-193) days, with the longest stays observed in patients who received combined treatment (P = 0.032).CONCLUSIONThis study provides a comprehensive overview of the current treatment strategies and outcomes for patients with Boerhaave syndrome in Europe.
{"title":"Treatment strategies for Boerhaave syndrome: multinational retrospective cohort study.","authors":"Tobias Hauge,Aram Abu Hejleh,Alberto Aiolfi,Felix Berlth,Luigi Bonavina,Linda Brake,Lena-Christin Conradi,Xavier Benoit D'Journo,David Edholm,Jessie Elliot,Wietse Eshuis,Nora Friedrich,Suzanne Gisbertz,Peter Grimminger,Christian Alexander Gutschow,Shantanu Joglekar,Bastiaan Klarenbeek,Fredrik Klevebro,Cezanne D Kooij,Misha Luyer,Alfio Milazzo,Lucia Moletta,Johnny Moons,Krishna Moorthy,Beat P Müller-Stich,Henrik Nienhüser,Philippe Nafteux,Giulia Nezi,Raphael Nico,Kerstin J Neuschütz,Grard Nieuwenhuijzen,Nicola Raftery,Franziska Renger,Ioannis Rouvelas,Jelle P Ruurda,Marcel A Schneider,Daniela Polette Stubb,Alban Todesco,Michele Valmasoni,Mark I van Berge Henegouwen,Elke van Daele,Richard van Hillegersberg,Sander J M van Hootegem,Hanne Vanommeslaeghe,Julie Veziant,Bas Wijnhoven,João Pedro Vilela,Christiane J Bruns,Magnus Nilsson,Wolfgang Schröder","doi":"10.1093/bjs/znaf260","DOIUrl":"https://doi.org/10.1093/bjs/znaf260","url":null,"abstract":"BACKGROUNDBoerhaave syndrome is defined as a spontaneous perforation of the oesophagus. The mainstay of treatment is resuscitation of the patient, closure of the oesophageal defect, and drainage of perioesophageal and pleural fluid collections. Whether the optimal approach is endoscopic, surgical, or conservative management remains unknown and there are no clear guidelines. The aim of this multicentre retrospective cohort study was to evaluate current treatment strategies and outcomes for Boerhaave syndrome.METHODSA multicentre retrospective analysis of data from 23 participating European tertiary centres was performed. Patients with Boerhaave syndrome treated between January 2019 and December 2023 were eligible for inclusion. The primary endpoint was the length of ICU stay and secondary endpoints included in-hospital mortality, 90-day mortality, and the length of overall hospital stay.RESULTSIn total, 216 patients were included; 151 were men (70%), the median age was 62 (22-95) years, and 81 (40%) were treated >24 h after the start of symptoms. Seventy (32%) patients were managed endoscopically (group I), 73 (34%) were managed surgically (group II), 67 (31%) were managed using a combination of endoscopy and surgery (group III), and 6 (3%) were managed using other methods (group IV). For patients in groups I-III: the median length of ICU stay was 8 (0-67) days, with no differences between the three groups (P = 0.105); the in-hospital mortality rate and 90-day mortality rate were both 12% (P = 0.490 and P = 0.637, respectively); and the median length of overall hospital stay was 27 (range 1-193) days, with the longest stays observed in patients who received combined treatment (P = 0.032).CONCLUSIONThis study provides a comprehensive overview of the current treatment strategies and outcomes for patients with Boerhaave syndrome in Europe.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"68 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645022","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}
Bo T M Strijbos,Imme Kraakman,Jana S Hopstaken,Jelle C van Dongen,Quisette P Janssen,Jacob L van Dam,Janine M Akkermans-Vogelaar,Marc G Besselink,Bert A Bonsing,Hendrik Bos,Koop P Bosscha,Jeroen Buijsen,Olivier R Busch,Ronald M van Dam,Ferry A L M Eskens,Sebastiaan Festen,Jan W B de Groot,Karin Groothuis,Brigitte C M Haberkorn,Ignace H J T de Hingh,Bronno van der Holt,Marjolein Y V Homs,Jeanin E van Hooft,Tom M Karsten,Emile D Kerver,Marion B van der Kolk,Cornelis J H M van Laarhoven,Mike S L Liem,Saskia A C Luelmo,Karen J Neelis,Joost Nuyttens,Gabriel M R M Paardekooper,Gijs A Patijn,Maurice J C van der Sangen,Hjalmar C van Santvoort,Mirte M Streppel,Mustafa Suker,Eva Versteijne,Pauline A J Vissers,Judith de Vos-Geelen,Johanna W Wilmink,Aeilko H Zwinderman,Casper H J van Eijck,Geertjan van Tienhoven,Bas Groot Koerkamp,Martijn W J Stommel,
{"title":"Delayed gastric emptying after pancreatic cancer surgery impacts time to start of adjuvant treatment but not overall survival: a post-hoc analysis of the PREOPANC-1 and -2 trials.","authors":"Bo T M Strijbos,Imme Kraakman,Jana S Hopstaken,Jelle C van Dongen,Quisette P Janssen,Jacob L van Dam,Janine M Akkermans-Vogelaar,Marc G Besselink,Bert A Bonsing,Hendrik Bos,Koop P Bosscha,Jeroen Buijsen,Olivier R Busch,Ronald M van Dam,Ferry A L M Eskens,Sebastiaan Festen,Jan W B de Groot,Karin Groothuis,Brigitte C M Haberkorn,Ignace H J T de Hingh,Bronno van der Holt,Marjolein Y V Homs,Jeanin E van Hooft,Tom M Karsten,Emile D Kerver,Marion B van der Kolk,Cornelis J H M van Laarhoven,Mike S L Liem,Saskia A C Luelmo,Karen J Neelis,Joost Nuyttens,Gabriel M R M Paardekooper,Gijs A Patijn,Maurice J C van der Sangen,Hjalmar C van Santvoort,Mirte M Streppel,Mustafa Suker,Eva Versteijne,Pauline A J Vissers,Judith de Vos-Geelen,Johanna W Wilmink,Aeilko H Zwinderman,Casper H J van Eijck,Geertjan van Tienhoven,Bas Groot Koerkamp,Martijn W J Stommel, ","doi":"10.1093/bjs/znaf261","DOIUrl":"https://doi.org/10.1093/bjs/znaf261","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"20 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645020","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}
Mads Marckmann,Nadia A Henriksen,Peter-Martin Krarup,Frederik Helgstrand,Peter Vester-Glowinski,M W Christoffersen,Kristian S Kiim
BACKGROUNDThe benefit of closed incision negative-pressure therapy (ciNPT) after open incisional hernia repair in reducing surgical-site infection (SSI) is uncertain.METHODSThe PROPRESS multicentre RCT was conducted from 1 March 2023 to 25 June 2024 at three Danish hospitals. Patients undergoing elective open incisional hernia repair were randomized to ciNPT or a standard wound dressing (SWD). The primary outcome was the incidence of SSI at 30 days. Secondary outcomes at 30 days included the pooled incidence of surgical-site occurrences (SSOs), patient-reported quality of life (QoL), and patient-reported scar assessment. The last follow-up date was 25 July 2024.RESULTSA total of 110 patients were randomized (54 SWD patients and 56 ciNPT patients; median age of 63.9 (interquartile range 50.7-69.0) years; 45 (40.1%) were female) and 108 (98.2%) completed follow-up at 30 days. In total, 7 of the 110 patients (6.4%) were smokers, the mean(s.d.) BMI was 29.3(4.1) kg/m2, and the mean(s.d.) horizontal defect size was 8.7(4.7) cm. One death in each group was unrelated to the intervention, but surgery and anaesthesia may have been predisposing factors for mortality. There was no difference in SSI rates; 4 of 53 patients (8%) in the SWD group versus 7 of 55 patients (13%) in the ciNPT group (P = 0.673). With regard to SSOs, these affected 12 of 53 patients (23%) in the SWD group versus 14 of 55 patients (26%) in the ciNPT group (P = 0.907). There was no difference in scar scores (equal mean scores of 24; P = 0.892) and overall QoL improved significantly (mean score difference: -12.8 (95% c.i. -15.4 to -10.2); P < 0.001) without a difference between the groups (mean score change: SWD -12.6 versus ciNPT -13.0; P = 0.874).CONCLUSIONciNPT did not reduce SSI after open incisional hernia repair in this RCT, which was limited by the relatively small number of patients.REGISTRATION NUMBERNCT05050786 (http://www.clinicaltrials.gov).
{"title":"Effect of standard wound dressing versus prophylactic closed incision negative-pressure therapy on surgical-site infection after open incisional hernia repair: multicentre randomized clinical trial.","authors":"Mads Marckmann,Nadia A Henriksen,Peter-Martin Krarup,Frederik Helgstrand,Peter Vester-Glowinski,M W Christoffersen,Kristian S Kiim","doi":"10.1093/bjs/znaf230","DOIUrl":"https://doi.org/10.1093/bjs/znaf230","url":null,"abstract":"BACKGROUNDThe benefit of closed incision negative-pressure therapy (ciNPT) after open incisional hernia repair in reducing surgical-site infection (SSI) is uncertain.METHODSThe PROPRESS multicentre RCT was conducted from 1 March 2023 to 25 June 2024 at three Danish hospitals. Patients undergoing elective open incisional hernia repair were randomized to ciNPT or a standard wound dressing (SWD). The primary outcome was the incidence of SSI at 30 days. Secondary outcomes at 30 days included the pooled incidence of surgical-site occurrences (SSOs), patient-reported quality of life (QoL), and patient-reported scar assessment. The last follow-up date was 25 July 2024.RESULTSA total of 110 patients were randomized (54 SWD patients and 56 ciNPT patients; median age of 63.9 (interquartile range 50.7-69.0) years; 45 (40.1%) were female) and 108 (98.2%) completed follow-up at 30 days. In total, 7 of the 110 patients (6.4%) were smokers, the mean(s.d.) BMI was 29.3(4.1) kg/m2, and the mean(s.d.) horizontal defect size was 8.7(4.7) cm. One death in each group was unrelated to the intervention, but surgery and anaesthesia may have been predisposing factors for mortality. There was no difference in SSI rates; 4 of 53 patients (8%) in the SWD group versus 7 of 55 patients (13%) in the ciNPT group (P = 0.673). With regard to SSOs, these affected 12 of 53 patients (23%) in the SWD group versus 14 of 55 patients (26%) in the ciNPT group (P = 0.907). There was no difference in scar scores (equal mean scores of 24; P = 0.892) and overall QoL improved significantly (mean score difference: -12.8 (95% c.i. -15.4 to -10.2); P < 0.001) without a difference between the groups (mean score change: SWD -12.6 versus ciNPT -13.0; P = 0.874).CONCLUSIONciNPT did not reduce SSI after open incisional hernia repair in this RCT, which was limited by the relatively small number of patients.REGISTRATION NUMBERNCT05050786 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"2 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613380","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: Axillary surgery versus no-axillary staging in T1N0 breast cancer: 20-year follow-up of the INT 09/98 randomized clinical trial.","authors":"","doi":"10.1093/bjs/znaf234","DOIUrl":"https://doi.org/10.1093/bjs/znaf234","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"169 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472767","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}
Angus R J Barber,Alexander Dottore,James Leigh,Mark Fear,Fiona Wood
BACKGROUNDRapid evaporative ionization mass spectrometry (REIMS) is an emerging technology facilitating real-time intraoperative tissue identification during surgery. This review aims to discuss the applications and reported outcomes of REIMS technology in a surgical context.METHODSA systematic review was performed using four electronic databases that were searched in August 2025: MEDLINE, Emcare, Embase, and Web of Science. Eligible studies were peer-reviewed, included five or more patients, and evaluated REIMS technology in the context of a surgical specialty or pathology. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the QUADAS-2 tool. The study protocol was registered in the PROSPERO international prospective register of systematic reviews before commencing the review (CRD42024546741).RESULTSA total of 344 records underwent initial screening, with 26 studies included. Included articles originated from seven countries and applied REIMS to eight surgical specialties. Twenty-three of the included articles used REIMS to identify cancerous tissue. All included studies reported both qualitative and quantitative outcomes. Included studies demonstrated a variety of surgical applications with promising results with regard to accuracy, sensitivity, and specificity. Both ex vivo and in vivo applications were explored, but limited in vivo data was reported and logistical limitations were identified.CONCLUSIONMost of the evidence supporting the use of REIMS in surgery originates from an ex vivo environment. Current limitations of the technique include equipment logistics and the complexity of interpretation of data and further in vivo studies with larger patient numbers are required to support more widespread application.
背景：快速蒸发电离质谱法（REIMS）是一种新兴的技术，可以在手术过程中实时识别术中组织。这篇综述旨在讨论REIMS技术在外科领域的应用和报道的结果。方法采用于2025年8月检索的MEDLINE、Emcare、Embase和Web of Science 4个电子数据库进行系统评价。符合条件的研究经过同行评审，包括5名或更多患者，并在外科专科或病理学背景下评估REIMS技术。两名独立审稿人筛选研究，提取数据，并使用QUADAS-2工具评估偏倚风险。在开始审查之前，该研究方案已在普洛斯彼罗国际前瞻性系统评价登记处注册（CRD42024546741）。结果共有344例患者接受了初步筛查，其中26例为研究。纳入来自7个国家的文章，并将REIMS应用于8个外科专科。纳入的文章中有23篇使用rems来识别癌组织。所有纳入的研究均报告了定性和定量结果。纳入的研究证明了各种外科应用，在准确性、敏感性和特异性方面都有很好的结果。研究人员探索了体外和体内的应用，但体内数据有限，并且确定了后勤限制。结论支持rems在手术中应用的证据大多来自离体环境。目前该技术的局限性包括设备后勤和数据解释的复杂性，需要更多患者数量的进一步体内研究来支持更广泛的应用。
{"title":"Rapid evaporative ionization mass spectrometry in surgery: a systematic review.","authors":"Angus R J Barber,Alexander Dottore,James Leigh,Mark Fear,Fiona Wood","doi":"10.1093/bjs/znaf228","DOIUrl":"https://doi.org/10.1093/bjs/znaf228","url":null,"abstract":"BACKGROUNDRapid evaporative ionization mass spectrometry (REIMS) is an emerging technology facilitating real-time intraoperative tissue identification during surgery. This review aims to discuss the applications and reported outcomes of REIMS technology in a surgical context.METHODSA systematic review was performed using four electronic databases that were searched in August 2025: MEDLINE, Emcare, Embase, and Web of Science. Eligible studies were peer-reviewed, included five or more patients, and evaluated REIMS technology in the context of a surgical specialty or pathology. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the QUADAS-2 tool. The study protocol was registered in the PROSPERO international prospective register of systematic reviews before commencing the review (CRD42024546741).RESULTSA total of 344 records underwent initial screening, with 26 studies included. Included articles originated from seven countries and applied REIMS to eight surgical specialties. Twenty-three of the included articles used REIMS to identify cancerous tissue. All included studies reported both qualitative and quantitative outcomes. Included studies demonstrated a variety of surgical applications with promising results with regard to accuracy, sensitivity, and specificity. Both ex vivo and in vivo applications were explored, but limited in vivo data was reported and logistical limitations were identified.CONCLUSIONMost of the evidence supporting the use of REIMS in surgery originates from an ex vivo environment. Current limitations of the technique include equipment logistics and the complexity of interpretation of data and further in vivo studies with larger patient numbers are required to support more widespread application.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"11 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491716","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}
Eoin P Kerin,John P M O'Donnell,Sami M Abd Elwahab,Thomas O Butler,Luis Bouz Mkabaah,Angie Fasoula,Giannis Papatrechas,Petros Arvanitis,Luc Duchesne,Michael K Barry,Aoife J Lowery,Michael J Kerin
{"title":"Diagnostic performance of the second-generation Wavelia microwave breast imaging system: a pilot clinical investigation.","authors":"Eoin P Kerin,John P M O'Donnell,Sami M Abd Elwahab,Thomas O Butler,Luis Bouz Mkabaah,Angie Fasoula,Giannis Papatrechas,Petros Arvanitis,Luc Duchesne,Michael K Barry,Aoife J Lowery,Michael J Kerin","doi":"10.1093/bjs/znaf242","DOIUrl":"https://doi.org/10.1093/bjs/znaf242","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"53 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491717","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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