Gino M Kuiper,Lianne Triemstra,Robin B den Boer,Franco Badaloni,Janneke P C Grutters,Maroeska Rovers,Richard van Hillegersberg,Jelle P Ruurda
BACKGROUNDRobot-assisted minimally invasive oesophagectomy (RAMIO) is increasingly used for oesophageal cancer surgery, yet its adoption may have outpaced structured evaluation. This systematic review assessed RAMIO's development through the IDEAL framework and synthesized evidence from RCTs and long-term studies.METHODSA systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library on 1 June 2025 for studies comparing RAMIO with open oesophagectomy or minimally invasive oesophagectomy. Non-comparative, non-English, protocol, and review articles were excluded. Two reviewers independently screened and extracted data, classifying studies according to IDEAL stages. Outcomes were presented in a narrative overview. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for long-term studies. The protocol was registered in PROSPERO (CRD42022352208).RESULTSA total of 104 studies involving 133 107 patients published between 2002 and 2025 were included. Of these, 86 were IDEAL stage 2B, four stage 3 (RCTs), and 14 stage 4 (long-term follow up studies). Generally, RAMIO research followed the IDEAL pathway, although several stage 4 studies preceded stage 3 evaluations. None explicitly referenced the IDEAL framework. RCTs demonstrated some benefits of RAMIO, including fewer complications and faster recovery, whereas long-term outcomes remain uncertain. Studies on long-term outcomes varied in design and were often at risk of bias.CONCLUSIONRAMIO may offer perioperative benefits, but high-quality evidence is limited. Few RCTs exist, and long-term benefits are unclear. Although RAMIO development aligns broadly with IDEAL stages, explicit framework adherence is lacking. Future trials should adopt structured IDEAL-guided designs and standardised reporting.
{"title":"Implementation and effectiveness of robot-assisted minimally invasive oesophagectomy (RAMIO): a systematic review using the IDEAL framework.","authors":"Gino M Kuiper,Lianne Triemstra,Robin B den Boer,Franco Badaloni,Janneke P C Grutters,Maroeska Rovers,Richard van Hillegersberg,Jelle P Ruurda","doi":"10.1093/bjs/znaf265","DOIUrl":"https://doi.org/10.1093/bjs/znaf265","url":null,"abstract":"BACKGROUNDRobot-assisted minimally invasive oesophagectomy (RAMIO) is increasingly used for oesophageal cancer surgery, yet its adoption may have outpaced structured evaluation. This systematic review assessed RAMIO's development through the IDEAL framework and synthesized evidence from RCTs and long-term studies.METHODSA systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library on 1 June 2025 for studies comparing RAMIO with open oesophagectomy or minimally invasive oesophagectomy. Non-comparative, non-English, protocol, and review articles were excluded. Two reviewers independently screened and extracted data, classifying studies according to IDEAL stages. Outcomes were presented in a narrative overview. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for long-term studies. The protocol was registered in PROSPERO (CRD42022352208).RESULTSA total of 104 studies involving 133 107 patients published between 2002 and 2025 were included. Of these, 86 were IDEAL stage 2B, four stage 3 (RCTs), and 14 stage 4 (long-term follow up studies). Generally, RAMIO research followed the IDEAL pathway, although several stage 4 studies preceded stage 3 evaluations. None explicitly referenced the IDEAL framework. RCTs demonstrated some benefits of RAMIO, including fewer complications and faster recovery, whereas long-term outcomes remain uncertain. Studies on long-term outcomes varied in design and were often at risk of bias.CONCLUSIONRAMIO may offer perioperative benefits, but high-quality evidence is limited. Few RCTs exist, and long-term benefits are unclear. Although RAMIO development aligns broadly with IDEAL stages, explicit framework adherence is lacking. Future trials should adopt structured IDEAL-guided designs and standardised reporting.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145704318","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}
Masaya Nakauchi,Colin Court,Henry S Walch,Miseker Abate,Shoji Shimada,Walid K Chatila,Laura H Tang,Daniel G Coit,Yelena Y Janjigian,Steven B Maron,Geoffrey Y Ku,David H Ilson,Nikolaus Schultz,Hiroshi Matsuoka,Tetsuya Tsukamoto,Ichiro Uyama,Koichi Suda,Vivian E Strong
INTRODUCTIONGastric cancer incidence, risk factors, and survival outcomes differ significantly between Japan and the United States. These disparities have led to the belief that gastric cancer represents biologically distinct diseases across regions. However, direct genomic comparisons of tumours from these populations have not been performed. The aim of this study was to compare the genomic and clinical characteristics of gastric cancers in patients from the US and Japan following curative-intent resection.METHODSA retrospective cohort study of patients who underwent curative-intent gastrectomy between 2010 and 2019 at Memorial Sloan Kettering (MSK, n = 142) and Fujita Health University (FHU, n = 108), with ≥5 years of follow-up, was conducted. Tumour samples underwent targeted sequencing. Clinical and genomic data were compared between unmatched and propensity score-matched (PSM) cohorts, matched by age, sex, clinical T/N-category, and tumour location (n = 58 each).RESULTSCommonly altered genes included TP53 (60%), ARID1A (17%), ERBB2 (14%), CCNE1 (13%), and KRAS (12%). MSK tumours showed higher rates of microsatellite instability (MSI-high; 22.4% versus 5.2%, P = 0.013) and KMT2D mutations (18% versus 5%, P < 0.05). Otherwise, gene- and pathway-level alterations were similar across unmatched, microsatellite stable only, and PSM cohorts. Five-year overall survival in PSM cohorts was comparable (MSK 60% versus FHU 69.4%, P = 0.548). Peritoneal recurrence was more common in the MSK cohort (47% versus 34%), but recurrence patterns were not associated with distinct genomic profiles.CONCLUSIONAfter adjustment for clinical covariates, US and Japanese gastric cancers exhibit comparable genomic landscapes and survival, supporting the relevance of clinical trial data across geographic settings.
日本和美国的胃癌发病率、危险因素和生存结局存在显著差异。这些差异导致人们相信，胃癌在不同地区代表着生物学上不同的疾病。然而，还没有对这些人群的肿瘤进行直接的基因组比较。本研究的目的是比较美国和日本胃癌患者在治疗目的切除后的基因组和临床特征。方法回顾性队列研究2010年至2019年期间在纪念斯隆凯特琳（MSK, n = 142）和藤田健康大学（FHU, n = 108）接受治愈性胃切除术的患者，随访≥5年。肿瘤样本进行了靶向测序。临床和基因组数据在未匹配和倾向评分匹配（PSM）队列之间进行比较，按年龄、性别、临床T/ n类别和肿瘤位置进行匹配（每个n = 58）。结果常见的改变基因包括TP53（60%）、ARID1A（17%）、ERBB2（14%）、CCNE1（13%）和KRAS（12%）。MSK肿瘤具有较高的微卫星不稳定性（msi高，22.4%比5.2%,P = 0.013）和KMT2D突变（18%比5%，P < 0.05）。否则，基因和通路水平的改变在未匹配的、微卫星稳定的和PSM队列中是相似的。PSM队列的5年总生存率具有可比性（MSK为60%，FHU为69.4%,P = 0.548）。腹膜复发在MSK队列中更为常见（47%对34%），但复发模式与不同的基因组谱无关。在调整临床协变量后，美国和日本的胃癌表现出相似的基因组景观和生存率，支持不同地理环境下临床试验数据的相关性。
{"title":"Genomic and clinical parallels between US and Japanese gastric cancers: a propensity score-matched cohort study.","authors":"Masaya Nakauchi,Colin Court,Henry S Walch,Miseker Abate,Shoji Shimada,Walid K Chatila,Laura H Tang,Daniel G Coit,Yelena Y Janjigian,Steven B Maron,Geoffrey Y Ku,David H Ilson,Nikolaus Schultz,Hiroshi Matsuoka,Tetsuya Tsukamoto,Ichiro Uyama,Koichi Suda,Vivian E Strong","doi":"10.1093/bjs/znaf280","DOIUrl":"https://doi.org/10.1093/bjs/znaf280","url":null,"abstract":"INTRODUCTIONGastric cancer incidence, risk factors, and survival outcomes differ significantly between Japan and the United States. These disparities have led to the belief that gastric cancer represents biologically distinct diseases across regions. However, direct genomic comparisons of tumours from these populations have not been performed. The aim of this study was to compare the genomic and clinical characteristics of gastric cancers in patients from the US and Japan following curative-intent resection.METHODSA retrospective cohort study of patients who underwent curative-intent gastrectomy between 2010 and 2019 at Memorial Sloan Kettering (MSK, n = 142) and Fujita Health University (FHU, n = 108), with ≥5 years of follow-up, was conducted. Tumour samples underwent targeted sequencing. Clinical and genomic data were compared between unmatched and propensity score-matched (PSM) cohorts, matched by age, sex, clinical T/N-category, and tumour location (n = 58 each).RESULTSCommonly altered genes included TP53 (60%), ARID1A (17%), ERBB2 (14%), CCNE1 (13%), and KRAS (12%). MSK tumours showed higher rates of microsatellite instability (MSI-high; 22.4% versus 5.2%, P = 0.013) and KMT2D mutations (18% versus 5%, P < 0.05). Otherwise, gene- and pathway-level alterations were similar across unmatched, microsatellite stable only, and PSM cohorts. Five-year overall survival in PSM cohorts was comparable (MSK 60% versus FHU 69.4%, P = 0.548). Peritoneal recurrence was more common in the MSK cohort (47% versus 34%), but recurrence patterns were not associated with distinct genomic profiles.CONCLUSIONAfter adjustment for clinical covariates, US and Japanese gastric cancers exhibit comparable genomic landscapes and survival, supporting the relevance of clinical trial data across geographic settings.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"39 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759991","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}
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}
Omer Al Kindi,Abulaziz Alenezi,Aoibheann E Walsh,Aoife J Lowery,Stewart R Walsh
{"title":"Zero-event trials in surgical meta-analyses: inconsistent handling.","authors":"Omer Al Kindi,Abulaziz Alenezi,Aoibheann E Walsh,Aoife J Lowery,Stewart R Walsh","doi":"10.1093/bjs/znaf273","DOIUrl":"https://doi.org/10.1093/bjs/znaf273","url":null,"abstract":"","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":"145759993","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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