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Compatibility of procreation, pregnancy, and early parenthood in female and male surgeons during surgical training in Switzerland: national survey study.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2025-02-01 DOI: 10.1093/bjs/znae314
Joana Ferreirinha, Markus Weber, Nicolas Attigah, Seraina Faes

Background: Lengthy training and stressful work schedules can cause surgeons to renounce part-time work and delay pregnancy. The aim of this survey study was to evaluate constraints of part-time work, procreation, pregnancy, and early parenthood among young surgeons in Switzerland.

Methods: An anonymous survey on different aspects of private life and surgical training was distributed to young board-certified general surgeons in Switzerland.

Results: Out of the 680 surveys sent, a total of 375 were completed (response rate of 55.1%), with 308 included for further analysis (157 from female participants and 151 from male participants). There was no difference between male and female participants in the time required for board and sub-specialty certification. Female participants had a higher rate (59 of 157 (37.6%) versus 28 of 151 (18.5%), P < 0.001) and longer duration (mean(s.d.) of 5.5(4.0) versus 1.8(1.1) years, P < 0.001) of part-time employment. Female participants less frequently had children (70 of 157 (44.6%) versus 106 of 151 (70.2%), P < 0.001). They were older (median age of 35 (interquartile range 33-37.5) years) than male participants (median age of 33.5 (interquartile range 31.75-35) years) (P < 0.001) and female partners of male participants (median age of 32 (interquartile range 30-33) years) (P < 0.001) at first childbirth. Female participants more frequently delayed pregnancy due to training (94 of 127 (74.0%) versus 28 of 138 (20.3%), P < 0.001) and had higher rates of infertility (16 of 70 (23%) versus 11 of 106 (10.4%), P = 0.032) and use of assisted reproductive technology (18 of 127 (14.2%) versus 6 of 138 (4.3%), P = 0.009). Female participants more frequently perceived their gender as a negative career influence (105 of 157 (66.9%) versus 9 of 151 (6.0%), P < 0.001).

Conclusion: Combining procreation, pregnancy, and early parenthood with surgical training is challenging for young surgeons in Switzerland. Providing equal opportunities for all genders and promoting changes in working conditions will be necessary to ensure optimal surgical training for future generations.

{"title":"Compatibility of procreation, pregnancy, and early parenthood in female and male surgeons during surgical training in Switzerland: national survey study.","authors":"Joana Ferreirinha, Markus Weber, Nicolas Attigah, Seraina Faes","doi":"10.1093/bjs/znae314","DOIUrl":"https://doi.org/10.1093/bjs/znae314","url":null,"abstract":"<p><strong>Background: </strong>Lengthy training and stressful work schedules can cause surgeons to renounce part-time work and delay pregnancy. The aim of this survey study was to evaluate constraints of part-time work, procreation, pregnancy, and early parenthood among young surgeons in Switzerland.</p><p><strong>Methods: </strong>An anonymous survey on different aspects of private life and surgical training was distributed to young board-certified general surgeons in Switzerland.</p><p><strong>Results: </strong>Out of the 680 surveys sent, a total of 375 were completed (response rate of 55.1%), with 308 included for further analysis (157 from female participants and 151 from male participants). There was no difference between male and female participants in the time required for board and sub-specialty certification. Female participants had a higher rate (59 of 157 (37.6%) versus 28 of 151 (18.5%), P < 0.001) and longer duration (mean(s.d.) of 5.5(4.0) versus 1.8(1.1) years, P < 0.001) of part-time employment. Female participants less frequently had children (70 of 157 (44.6%) versus 106 of 151 (70.2%), P < 0.001). They were older (median age of 35 (interquartile range 33-37.5) years) than male participants (median age of 33.5 (interquartile range 31.75-35) years) (P < 0.001) and female partners of male participants (median age of 32 (interquartile range 30-33) years) (P < 0.001) at first childbirth. Female participants more frequently delayed pregnancy due to training (94 of 127 (74.0%) versus 28 of 138 (20.3%), P < 0.001) and had higher rates of infertility (16 of 70 (23%) versus 11 of 106 (10.4%), P = 0.032) and use of assisted reproductive technology (18 of 127 (14.2%) versus 6 of 138 (4.3%), P = 0.009). Female participants more frequently perceived their gender as a negative career influence (105 of 157 (66.9%) versus 9 of 151 (6.0%), P < 0.001).</p><p><strong>Conclusion: </strong>Combining procreation, pregnancy, and early parenthood with surgical training is challenging for young surgeons in Switzerland. Providing equal opportunities for all genders and promoting changes in working conditions will be necessary to ensure optimal surgical training for future generations.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 2","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481813","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}
引用次数: 0
Retraction of: FP5.8 - Bridging the Trust Divide: How Medical AI Outperforms yet Battles to Win Public Confidence - A Study Conducted Among 74 UK Residents.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2025-02-01 DOI: 10.1093/bjs/znaf039
{"title":"Retraction of: FP5.8 - Bridging the Trust Divide: How Medical AI Outperforms yet Battles to Win Public Confidence - A Study Conducted Among 74 UK Residents.","authors":"","doi":"10.1093/bjs/znaf039","DOIUrl":"https://doi.org/10.1093/bjs/znaf039","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 2","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397694","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}
引用次数: 0
Utility of New Injury Severity Score (NISS) in assessing bullfighting trauma: experience from a level I hospital.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2025-02-01 DOI: 10.1093/bjs/znaf015
Manuel José Torres-Jurado, Juan Ramón Gómez-López, Jeancarlos Jhosmer Trujillo-Díaz, Francesco Schenone, Ana Benítez-Riesco, María Pilar Concejo-Cutoli, Laura Vicente-González, Carlos Vaquero Puerta, Juan Carlos Martín-Del Olmo
{"title":"Utility of New Injury Severity Score (NISS) in assessing bullfighting trauma: experience from a level I hospital.","authors":"Manuel José Torres-Jurado, Juan Ramón Gómez-López, Jeancarlos Jhosmer Trujillo-Díaz, Francesco Schenone, Ana Benítez-Riesco, María Pilar Concejo-Cutoli, Laura Vicente-González, Carlos Vaquero Puerta, Juan Carlos Martín-Del Olmo","doi":"10.1093/bjs/znaf015","DOIUrl":"https://doi.org/10.1093/bjs/znaf015","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 2","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187762","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}
引用次数: 0
Carbohydrate antigen 19-9 (CA19-9) response after induction FOLFIRINOX for locally advanced pancreatic cancer identifies patients who may benefit from surgical exploration: multicentre, observational cohort study.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2025-02-01 DOI: 10.1093/bjs/znaf011
Esther N Dekker, David van Klaveren, Eva M M Verkolf, Roeland F de Wilde, Marc G Besselink, Eileen M O'Reilly, Alessandro Paniccia, Matthew H G Katz, Ching-Wei D Tzeng, Alice C Wei, Amer H Zureikat, Bas Groot Koerkamp

Background: Which patients with locally advanced pancreatic cancer may benefit from surgical exploration after induction treatment remains debated. The aim of this retrospective cohort study was to identify independent factors for overall survival after surgical exploration for locally advanced pancreatic cancer, which are available at restaging after induction therapy.

Methods: Consecutive patients with locally advanced pancreatic cancer from the Trans-Atlantic Pancreatic Surgery cohort who underwent surgical exploration after FOLFIRINOX as induction chemotherapy were included. Multivariable Cox proportional hazards analyses with contour plots were used for the predicted 3-year overall survival in patients who underwent surgical exploration.

Results: Overall, 958 patients with locally advanced pancreatic cancer were treated with FOLFIRINOX as induction therapy. At restaging, 221 patients (23.1%) had metastatic disease (M1) and 724 patients (75.6%) did not have metastatic disease (M0)-234 patients (24.4%) with M0 disease underwent surgical exploration and 490 patients (51.1%) with M0 disease did not undergo surgical exploration; restaging information was not available for 13 patients (1%). The surgical exploration cohort included 213 patients with locally advanced pancreatic cancer, after excluding 21 carbohydrate antigen 19-9 non-producers. The independent prognostic factors for overall survival after surgical exploration were post-induction carbohydrate antigen 19-9 level (HR 1.14 (95% c.i. 1.01 to 1.29)), carbohydrate antigen 19-9 decrease (HR 0.89 (95% c.i. 0.79 to 0.99)), and a WHO performance status of greater than or equal to one (HR 1.71 (95% c.i. 1.21 to 2.42)). Baseline carbohydrate antigen 19-9 was not prognostic for overall survival after surgical exploration (HR 0.98 (95% c.i. 0.90 to 1.07)). The best predicted 3-year overall survival was achieved with a greater than 80% decrease in carbohydrate antigen 19-9 and a post-induction carbohydrate antigen 19-9 less than 50 U/ml.

Conclusion: Carbohydrate antigen 19-9 after induction therapy, carbohydrate antigen 19-9 decrease, and performance status are independent prognostic factors for overall survival after surgical exploration for locally advanced pancreatic cancer. Three-year overall survival is best in patients with a performance status of zero, a greater than 80% decrease in carbohydrate antigen 19-9, and a post-induction carbohydrate antigen 19-9 level less than 50 U/ml.

{"title":"Carbohydrate antigen 19-9 (CA19-9) response after induction FOLFIRINOX for locally advanced pancreatic cancer identifies patients who may benefit from surgical exploration: multicentre, observational cohort study.","authors":"Esther N Dekker, David van Klaveren, Eva M M Verkolf, Roeland F de Wilde, Marc G Besselink, Eileen M O'Reilly, Alessandro Paniccia, Matthew H G Katz, Ching-Wei D Tzeng, Alice C Wei, Amer H Zureikat, Bas Groot Koerkamp","doi":"10.1093/bjs/znaf011","DOIUrl":"10.1093/bjs/znaf011","url":null,"abstract":"<p><strong>Background: </strong>Which patients with locally advanced pancreatic cancer may benefit from surgical exploration after induction treatment remains debated. The aim of this retrospective cohort study was to identify independent factors for overall survival after surgical exploration for locally advanced pancreatic cancer, which are available at restaging after induction therapy.</p><p><strong>Methods: </strong>Consecutive patients with locally advanced pancreatic cancer from the Trans-Atlantic Pancreatic Surgery cohort who underwent surgical exploration after FOLFIRINOX as induction chemotherapy were included. Multivariable Cox proportional hazards analyses with contour plots were used for the predicted 3-year overall survival in patients who underwent surgical exploration.</p><p><strong>Results: </strong>Overall, 958 patients with locally advanced pancreatic cancer were treated with FOLFIRINOX as induction therapy. At restaging, 221 patients (23.1%) had metastatic disease (M1) and 724 patients (75.6%) did not have metastatic disease (M0)-234 patients (24.4%) with M0 disease underwent surgical exploration and 490 patients (51.1%) with M0 disease did not undergo surgical exploration; restaging information was not available for 13 patients (1%). The surgical exploration cohort included 213 patients with locally advanced pancreatic cancer, after excluding 21 carbohydrate antigen 19-9 non-producers. The independent prognostic factors for overall survival after surgical exploration were post-induction carbohydrate antigen 19-9 level (HR 1.14 (95% c.i. 1.01 to 1.29)), carbohydrate antigen 19-9 decrease (HR 0.89 (95% c.i. 0.79 to 0.99)), and a WHO performance status of greater than or equal to one (HR 1.71 (95% c.i. 1.21 to 2.42)). Baseline carbohydrate antigen 19-9 was not prognostic for overall survival after surgical exploration (HR 0.98 (95% c.i. 0.90 to 1.07)). The best predicted 3-year overall survival was achieved with a greater than 80% decrease in carbohydrate antigen 19-9 and a post-induction carbohydrate antigen 19-9 less than 50 U/ml.</p><p><strong>Conclusion: </strong>Carbohydrate antigen 19-9 after induction therapy, carbohydrate antigen 19-9 decrease, and performance status are independent prognostic factors for overall survival after surgical exploration for locally advanced pancreatic cancer. Three-year overall survival is best in patients with a performance status of zero, a greater than 80% decrease in carbohydrate antigen 19-9, and a post-induction carbohydrate antigen 19-9 level less than 50 U/ml.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 2","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447794","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}
引用次数: 0
Preoperative stereotactic radiotherapy to prevent pancreatic fistula in high-risk patients undergoing pancreatoduodenectomy (FIBROPANC): prospective multicentre phase II single-arm trial.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2025-02-01 DOI: 10.1093/bjs/znae327
Leonoor V Wismans, Tessa E Hendriks, J Annelie Suurmeijer, Joost J Nuyttens, Anna M Bruynzeel, Martijn P Intven, Lydi M van Driel, Roel Haen, Roeland F de Wilde, Bas Groot Koerkamp, Olivier R Busch, Jaap Stoker, Joanne Verheij, Arantza Farina, Onno J de Boer, Michail Doukas, Ignace H de Hingh, Daan J Lips, Erwin van der Harst, Geertjan van Tienhoven, Casper H van Eijck, Marc G Besselink

Background: Postoperative pancreatic fistula is the main driver of morbidity and mortality after pancreatoduodenectomy. In high-risk patients, the rate of postoperative pancreatic fistula approaches 50%, whereas it is below 5% in patients with pancreatic cancer who receive neoadjuvant chemoradiotherapy. The aim of this study was to evaluate the safety, feasibility, and efficacy of preoperative stereotactic body radiotherapy on the pancreatic neck transection margin in high-risk patients undergoing pancreatoduodenectomy to prevent postoperative pancreatic fistula.

Methods: In this prospective multicentre open-label single-arm trial (progressing from a safety run-in phase to a phase II design), patients undergoing pancreatoduodenectomy for neoplasms other than pancreatic ductal adenocarcinoma received a single preoperative stereotactic body radiotherapy dose of 12 Gy. Primary endpoints included safety (less than or equal to 15% grade 3-5 toxicity), feasibility (a significant change in pancreatic texture measured using a durometer), and efficacy (a 15% reduction in the grade B/C postoperative pancreatic fistula rate compared with patients from the Dutch Pancreatic Cancer Audit who were eligible but not included in this study). Secondary endpoints assessed tissue fibrosis (collagen density).

Results: Overall, 38 patients were included, of whom 33 (87%) completed the study protocol and were included in the per-protocol analysis. The safety cut-off was met, with 3% grade 3-5 toxicity. Pancreatic tissue treated with stereotactic body radiotherapy showed increased firmness using a durometer (median of 47 (interquartile range 36-57) versus 37 (interquartile range 30-41) Shore OO units; P < 0.001) and a higher collagen density (median of 6.1% (interquartile range 4.4%-9.5%) versus 4.6% (interquartile range 2.5%-7.4%); P = 0.003). The grade B/C postoperative pancreatic fistula rate with stereotactic body radiotherapy was 57.6% (95% c.i. 41% to 74%), compared with 34% (95% c.i. 27% to 42%) in audit controls (P = 0.011).

Conclusion: Preoperative stereotactic body radiotherapy is safe in high-risk patients undergoing pancreatoduodenectomy and increases parenchymal firmness and fibrosis, but fails to show evidence of efficacy.

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引用次数: 0
Multicentre prospective study on the diagnostic and prognostic validity of malnutrition assessment tools in surgery.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2025-02-01 DOI: 10.1093/bjs/znaf013
Georgia Petra, Evangelos I Kritsotakis, Nikolaos Gouvas, Dimitrios Schizas, Konstantinos Toutouzas, Michael Karanikas, George Pappas-Gogos, Georgios Stylianidis, George Zacharioudakis, Aggelos Laliotis, Grigorios Christodoulidis, Ioannis Kehagias, Konstantinos Lasithiotakis

Background: Malnutrition is a risk factor for postoperative morbidity but the optimal tool for the assessment of malnutrition is unclear.

Methods: This is a prospective multicentre cohort study. Consecutive patients undergoing elective or emergency major abdominal surgery for benign or malignant disease in 12 Greek hospitals between January 2022 and December 2023 were included. Patients unable to provide nutrition history and/or informed consent were excluded. Subjective global assessment (SGA) was used as a reference standard for malnutrition diagnosis. GLIM (global leadership initiative on malnutrition), MNA-SF (mini nutrition assessment short form), MST (malnutrition screening tool), MUST (malnutrition universal screening tool), NRI (nutritional risk index), NRS-2002 (nutrition risk scale 2002), PONS (perioperative nutrition screen) and SNAQ (short nutrition assessment questionnaire) tools were applied for malnutrition risk assessments. Indicators of diagnostic accuracy (sensitivity, specificity, diagnostic odds ratio, areas under the receiver operating characteristic curve-AUC), construct validity (convergent associations with relevant variables) and prognostic validity (logistic regression) were appraised.

Results: 1649 patients were included (58% colorectal, 21% upper gastrointestinal, 14% hepatobiliary operations). SGA defined 562 (34.1%) patients as malnourished with excellent construct and prognostic validity. Malnutrition risk assessments varied from 24.0% using NRS-2002 to 58.6% with the MNA-SF. On their ordinal scales, MNA-SF (AUC = 0.83, 95% c.i. 0.81 to 0.85) and MUST (AUC = 0.79, 95% c.i. 0.77 to 0.82) had the best discriminatory abilities with minimal between-centre heterogeneity. As binary classifiers, MNA-SF (OR = 30.2; 95% c.i. 20.2 to 45.1) and MUST (OR = 16.1; 95% c.i. 12.4 to 21.1) had the highest diagnostic ORs but only MUST had sensitivity and specificity close to 80%. MUST performed well in construct and prognostic validity appraisals.

Conclusion: This study supports the use of the MUST as it is the most valid nutritional screening tool in patients after major abdominal surgery.

{"title":"Multicentre prospective study on the diagnostic and prognostic validity of malnutrition assessment tools in surgery.","authors":"Georgia Petra, Evangelos I Kritsotakis, Nikolaos Gouvas, Dimitrios Schizas, Konstantinos Toutouzas, Michael Karanikas, George Pappas-Gogos, Georgios Stylianidis, George Zacharioudakis, Aggelos Laliotis, Grigorios Christodoulidis, Ioannis Kehagias, Konstantinos Lasithiotakis","doi":"10.1093/bjs/znaf013","DOIUrl":"10.1093/bjs/znaf013","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is a risk factor for postoperative morbidity but the optimal tool for the assessment of malnutrition is unclear.</p><p><strong>Methods: </strong>This is a prospective multicentre cohort study. Consecutive patients undergoing elective or emergency major abdominal surgery for benign or malignant disease in 12 Greek hospitals between January 2022 and December 2023 were included. Patients unable to provide nutrition history and/or informed consent were excluded. Subjective global assessment (SGA) was used as a reference standard for malnutrition diagnosis. GLIM (global leadership initiative on malnutrition), MNA-SF (mini nutrition assessment short form), MST (malnutrition screening tool), MUST (malnutrition universal screening tool), NRI (nutritional risk index), NRS-2002 (nutrition risk scale 2002), PONS (perioperative nutrition screen) and SNAQ (short nutrition assessment questionnaire) tools were applied for malnutrition risk assessments. Indicators of diagnostic accuracy (sensitivity, specificity, diagnostic odds ratio, areas under the receiver operating characteristic curve-AUC), construct validity (convergent associations with relevant variables) and prognostic validity (logistic regression) were appraised.</p><p><strong>Results: </strong>1649 patients were included (58% colorectal, 21% upper gastrointestinal, 14% hepatobiliary operations). SGA defined 562 (34.1%) patients as malnourished with excellent construct and prognostic validity. Malnutrition risk assessments varied from 24.0% using NRS-2002 to 58.6% with the MNA-SF. On their ordinal scales, MNA-SF (AUC = 0.83, 95% c.i. 0.81 to 0.85) and MUST (AUC = 0.79, 95% c.i. 0.77 to 0.82) had the best discriminatory abilities with minimal between-centre heterogeneity. As binary classifiers, MNA-SF (OR = 30.2; 95% c.i. 20.2 to 45.1) and MUST (OR = 16.1; 95% c.i. 12.4 to 21.1) had the highest diagnostic ORs but only MUST had sensitivity and specificity close to 80%. MUST performed well in construct and prognostic validity appraisals.</p><p><strong>Conclusion: </strong>This study supports the use of the MUST as it is the most valid nutritional screening tool in patients after major abdominal surgery.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 2","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555379","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}
引用次数: 0
Laparoscopic cholecystectomy versus conservative management for uncomplicated symptomatic gallstones: economic evaluation based on the C-GALL trial. 腹腔镜胆囊切除术与保守治疗无并发症症状性胆结石:基于C-GALL试验的经济评价
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-12-24 DOI: 10.1093/bjs/znae293
Rodolfo A Hernández, Irfan Ahmed, Karen Edwards, Jemma Hudson, Katie Gillies, Rebecca Bruce, Victoria Bell, Alison Avenell, Jane Blazeby, Miriam Brazzelli, Seonaidh Cotton, Bernard Croal, Graeme MacLennan, Peter Murchie, Craig R Ramsay
{"title":"Laparoscopic cholecystectomy versus conservative management for uncomplicated symptomatic gallstones: economic evaluation based on the C-GALL trial.","authors":"Rodolfo A Hernández, Irfan Ahmed, Karen Edwards, Jemma Hudson, Katie Gillies, Rebecca Bruce, Victoria Bell, Alison Avenell, Jane Blazeby, Miriam Brazzelli, Seonaidh Cotton, Bernard Croal, Graeme MacLennan, Peter Murchie, Craig R Ramsay","doi":"10.1093/bjs/znae293","DOIUrl":"10.1093/bjs/znae293","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 1","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996844","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}
引用次数: 0
Tumour deposit count is an independent prognostic factor in colorectal cancer-a population-based cohort study. 肿瘤沉积物计数是结直肠癌的独立预后因素——一项基于人群的队列研究。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-12-24 DOI: 10.1093/bjs/znae309
Simon Lundström, Erik Agger, Marie-Louise Lydrup, Fredrik Jörgren, Pamela Buchwald

Background: Tumour deposits are a prognostic factor for overall survival and distant metastasis in lymph node-negative colorectal cancer. However, the current TNM staging system does not account for the presence of tumour deposits in lymph node-positive colorectal cancer, or for the presence of multiple deposits. This study aimed to investigate the prognostic effect of tumour deposit count in patients with colorectal cancer.

Methods: Patients who underwent curative surgery for colorectal cancer between 2016 and 2019 were identified nationwide from the Swedish Colorectal Cancer Registry. Patients with undisclosed tumour deposit status/count and stage IV disease were excluded. Univariable and multivariable Cox regression analyses were used to assess the prognostic effect of tumour deposit count on overall survival and distant metastasis adjusted for age, sex, neoadjuvant treatment, and number of positive lymph nodes.

Results: Of 18 913 patients assessed, 14 154 patients were analysed with tumour deposits (TDs) present in 1702 (12%) patients. Patients were stratified by tumour deposit count (0, 1, 2, 3, 4, and ≥5 TDs). Increased tumour deposit count was associated with decreased 5-year overall survival (79%, 70%, 61%, 66%, 50%, 49%) and increased 5-year risk for distant metastasis (14%, 26%, 35%, 41%, 48%, 54%) respectively. Tumour deposit count remained an independent negative prognostic factor after multivariable Cox regression analysis.

Conclusion: Tumour deposit count is a negative prognostic predictor of both overall survival and distant metastasis in colorectal cancer, independent of positive lymph nodes or neoadjuvant treatment. These findings suggest that tumour deposit count should be integrated into the TNM staging regardless of lymph nodes status to improve prognostic accuracy.

背景:肿瘤沉积是影响淋巴结阴性结直肠癌总体生存和远处转移的预后因素。然而,目前的TNM分期系统并没有考虑到淋巴结阳性结直肠癌中肿瘤沉积物的存在,或者多重沉积物的存在。本研究旨在探讨肿瘤沉积计数对结直肠癌患者预后的影响。方法:从瑞典结直肠癌登记处确定2016年至2019年期间在全国范围内接受根治性结直肠癌手术的患者。排除未披露肿瘤沉积状态/计数和IV期疾病的患者。采用单变量和多变量Cox回归分析来评估肿瘤沉积计数对总体生存和远处转移的预后影响,并根据年龄、性别、新辅助治疗和阳性淋巴结数量进行调整。结果:18913例患者中,14154例患者中1702例(12%)存在肿瘤沉积(TDs)。根据肿瘤沉积计数(0、1、2、3、4和≥5个TDs)对患者进行分层。肿瘤沉积物数量增加分别与5年总生存率降低(79%、70%、61%、66%、50%、49%)和远处转移的5年风险增加(14%、26%、35%、41%、48%、54%)相关。多变量Cox回归分析后,肿瘤沉积计数仍然是一个独立的负面预后因素。结论:肿瘤沉积计数是结直肠癌总生存和远处转移的阴性预后预测因子,与淋巴结阳性或新辅助治疗无关。这些发现表明,无论淋巴结状态如何,肿瘤沉积物计数都应纳入TNM分期,以提高预后准确性。
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引用次数: 0
Contemporary management of phyllodes tumours of the breast: proposal for recommendations from the UK Association of Breast Surgery. 乳腺叶状肿瘤的当代管理:英国乳腺外科协会的建议。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-12-24 DOI: 10.1093/bjs/znae277
Mai K Bishr, Alex Humphreys, Mahbubl Ahmed, Karina Cox, Adam Hughes, Jennifer Isherwood, Sarah Pinder, Dionysios Dennis Remoundos, Elinor Sawyer, Muhammad Sarmad Tamimy, Lisa Whisker

Phyllodes tumours of the breast are rare fibroepithelial neoplasms classified histologically into benign, borderline, or malignant; each requiring different treatment strategies. The infrequency of presentation can result in diagnostic and management variability. The aim is to provide evidence-based or expert consensus recommendations for multidisciplinary teams managing patients with phyllodes tumours.

乳腺叶状瘤是一种罕见的纤维上皮肿瘤,在组织学上可分为良性、交界性和恶性;每个都需要不同的治疗策略。罕见的表现可能导致诊断和管理的可变性。目的是为管理叶状肿瘤患者的多学科团队提供循证或专家共识建议。
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引用次数: 0
Metagenomic next-generation sequencing for the detection of bacterial translocation in the blood of patients following liver, biliary tract or pancreatic surgery.
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-12-24 DOI: 10.1093/bjs/znae326
Zhenfeng Deng, Zhujing Lan, Huaitao Zhu, Hongbing Ren, Zongrui Jin, Jiajun Jiang, Tiansheng Lan, Jinyuan Zhou, Jilong Wang, Peiqi Wan, Ya Guo, Banghao Xu, Hai Zhu, Zhang Wen
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引用次数: 0
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British Journal of Surgery
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