Anouk M L H Emmen,Bram L J van den Broek,Tessa E Hendriks,Olivier R Busch,Bert A Bonsing,Marie L Cappelle,Peter-Paul L O Coene,Sebastiaan Festen,Erwin van der Harst,Ignace H J T de Hingh,Cees J H M van Laarhoven,Daan J Lips,Joost Sprakel,Misha D P Luyer,J Sven D Mieog,Hjalmar C van Santvoort,George van der Schelling,Jan H Wijsman,Gijs A Patijn,Roeland F de Wilde,Maurice J W Zwart,Wouter J M Derksen,I Quintus Molenaar,Bas Groot Koerkamp,Marc G Besselink,
BACKGROUNDRobotic pancreatoduodenectomy (RPD) is increasingly being implemented to enhance patient recovery, but it is unclear what happens to patient outcomes after the initial learning curve. The aim of this study was to evaluate the first 1000 consecutive RPD performed in the Netherlands.METHODSA nationwide analysis of patients who underwent RPD in 13 centres (March 2016-August 2023) from the Dutch Pancreatic Cancer Audit was performed. Patients were grouped based on published learning curve cut-offs (phases 1-4): 1-15, 16-62, 63-84, and >84 RPD per centre respectively. Outcomes were compared between the four learning curve phases. Ideal Outcome rates were used to compare outcomes between centres.RESULTSOverall, 1000 patients after RPD were included. The conversion rate was 10.1%, the rate of Clavien-Dindo complications of grade ≥III was 41.3%, the rate of postoperative pancreatic fistula of grade B/C was 24.4%, and the rate of in-hospital/30-day mortality was 3.9%. Of the patients, 71.1% had a high updated alternative fistula risk score. Improvements between the phases were found for five outcomes: median operating time (420, 360, 349, and 369 min respectively; P < 0.001), conversion rate (21.7%, 10.0%, 2.8%, and 7.5% respectively; P < 0.001), rate of delayed gastric emptying (DGE) of grade B/C (32.3%, 22.6%, 15.4%, and 20.2% respectively; P = 0.003), reoperation rate (9.9%, 11.3%, 9.8%, and 4.9% respectively; P = 0.026), and median duration of hospital stay (12, 11, 10, and 10 days respectively; P = 0.035). The rate of Clavien-Dindo complications of grade ≥III and the rate of in-hospital/30-day mortality remained stable. The Ideal Outcome rate (mean 47%) did not differ between centres.CONCLUSIONAcross four learning curve phases in a nationwide cohort, improvements were observed for operating time, conversion rate, rate of DGE of grade B/C, reoperation rate, and duration of hospital stay.
{"title":"Nationwide outcomes of 1000 robotic pancreatoduodenectomies across the four phases of the learning curve.","authors":"Anouk M L H Emmen,Bram L J van den Broek,Tessa E Hendriks,Olivier R Busch,Bert A Bonsing,Marie L Cappelle,Peter-Paul L O Coene,Sebastiaan Festen,Erwin van der Harst,Ignace H J T de Hingh,Cees J H M van Laarhoven,Daan J Lips,Joost Sprakel,Misha D P Luyer,J Sven D Mieog,Hjalmar C van Santvoort,George van der Schelling,Jan H Wijsman,Gijs A Patijn,Roeland F de Wilde,Maurice J W Zwart,Wouter J M Derksen,I Quintus Molenaar,Bas Groot Koerkamp,Marc G Besselink, ","doi":"10.1093/bjs/znaf210","DOIUrl":"https://doi.org/10.1093/bjs/znaf210","url":null,"abstract":"BACKGROUNDRobotic pancreatoduodenectomy (RPD) is increasingly being implemented to enhance patient recovery, but it is unclear what happens to patient outcomes after the initial learning curve. The aim of this study was to evaluate the first 1000 consecutive RPD performed in the Netherlands.METHODSA nationwide analysis of patients who underwent RPD in 13 centres (March 2016-August 2023) from the Dutch Pancreatic Cancer Audit was performed. Patients were grouped based on published learning curve cut-offs (phases 1-4): 1-15, 16-62, 63-84, and >84 RPD per centre respectively. Outcomes were compared between the four learning curve phases. Ideal Outcome rates were used to compare outcomes between centres.RESULTSOverall, 1000 patients after RPD were included. The conversion rate was 10.1%, the rate of Clavien-Dindo complications of grade ≥III was 41.3%, the rate of postoperative pancreatic fistula of grade B/C was 24.4%, and the rate of in-hospital/30-day mortality was 3.9%. Of the patients, 71.1% had a high updated alternative fistula risk score. Improvements between the phases were found for five outcomes: median operating time (420, 360, 349, and 369 min respectively; P < 0.001), conversion rate (21.7%, 10.0%, 2.8%, and 7.5% respectively; P < 0.001), rate of delayed gastric emptying (DGE) of grade B/C (32.3%, 22.6%, 15.4%, and 20.2% respectively; P = 0.003), reoperation rate (9.9%, 11.3%, 9.8%, and 4.9% respectively; P = 0.026), and median duration of hospital stay (12, 11, 10, and 10 days respectively; P = 0.035). The rate of Clavien-Dindo complications of grade ≥III and the rate of in-hospital/30-day mortality remained stable. The Ideal Outcome rate (mean 47%) did not differ between centres.CONCLUSIONAcross four learning curve phases in a nationwide cohort, improvements were observed for operating time, conversion rate, rate of DGE of grade B/C, reoperation rate, and duration of hospital stay.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"18 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472766","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}
Emanuele C Grasso,Roberto G Aru,Federico F Pennetta,Thomas Le Houérou,Dominique Fabre,Stéphan Haulon
INTRODUCTIONRepair of aortic arch aneurysms is challenging whether by open surgery or endovascular techniques. The aim of this study was to analyse the midterm outcomes of an innovative endovascular thoracic aortic stent-graft with a triple branch design (Cook Medical, Bloomington, IN, USA) and to compare the outcomes in patients with a retrograde or an antegrade branch for the left common carotid artery (LCCA).METHODSAll patients treated with the custom-made triple-branch arch device between October 2018 and April 2025 at a single tertiary-care hospital were enrolled. Demographics, co-morbidities, indication for the procedure, procedural details, and outcomes were recorded. The primary aim was to evaluate midterm clinical outcomes, including branch primary patency and reintervention rates. The secondary aim was to compare outcomes based on LCCA branch orientation.RESULTSSome patients were treated. Indications were degenerative (49%) or post-dissection (51%) arch aneurysms. Percutaneous approach was more common in the retrograde group (74% versus 24%, P < 0.001), which also had shorter operative times (160.5 versus 234.0 min, P < 0.001). Thirty-day stroke occurred in five patients (7%; 3% retrograde versus 11% antegrade, P = 0.361). Thirty-day mortality was 3% (3% versus 3%, P = 1) and postoperative heart failure developed in three patients (6% versus 3%, P = 0.599). Median follow-up was 35.8 months (i.q.r. 17.5-62.6 months). During follow-up, 8 patients died (11%) and 14 (19%) required reintervention. Branch primary patency was 100%.CONCLUSIONSEndovascular aortic arch repair with a triple-branch device is associated with favourable early outcomes. A retrograde LCCA branch orientation was associated with shorter operative times, and an increased potential for a totally percutaneous approach. Multicentre studies are required to confirm these findings and evaluate long-term outcomes.
{"title":"Endovascular aortic arch repair with a triple branch arch device.","authors":"Emanuele C Grasso,Roberto G Aru,Federico F Pennetta,Thomas Le Houérou,Dominique Fabre,Stéphan Haulon","doi":"10.1093/bjs/znaf227","DOIUrl":"https://doi.org/10.1093/bjs/znaf227","url":null,"abstract":"INTRODUCTIONRepair of aortic arch aneurysms is challenging whether by open surgery or endovascular techniques. The aim of this study was to analyse the midterm outcomes of an innovative endovascular thoracic aortic stent-graft with a triple branch design (Cook Medical, Bloomington, IN, USA) and to compare the outcomes in patients with a retrograde or an antegrade branch for the left common carotid artery (LCCA).METHODSAll patients treated with the custom-made triple-branch arch device between October 2018 and April 2025 at a single tertiary-care hospital were enrolled. Demographics, co-morbidities, indication for the procedure, procedural details, and outcomes were recorded. The primary aim was to evaluate midterm clinical outcomes, including branch primary patency and reintervention rates. The secondary aim was to compare outcomes based on LCCA branch orientation.RESULTSSome patients were treated. Indications were degenerative (49%) or post-dissection (51%) arch aneurysms. Percutaneous approach was more common in the retrograde group (74% versus 24%, P < 0.001), which also had shorter operative times (160.5 versus 234.0 min, P < 0.001). Thirty-day stroke occurred in five patients (7%; 3% retrograde versus 11% antegrade, P = 0.361). Thirty-day mortality was 3% (3% versus 3%, P = 1) and postoperative heart failure developed in three patients (6% versus 3%, P = 0.599). Median follow-up was 35.8 months (i.q.r. 17.5-62.6 months). During follow-up, 8 patients died (11%) and 14 (19%) required reintervention. Branch primary patency was 100%.CONCLUSIONSEndovascular aortic arch repair with a triple-branch device is associated with favourable early outcomes. A retrograde LCCA branch orientation was associated with shorter operative times, and an increased potential for a totally percutaneous approach. Multicentre studies are required to confirm these findings and evaluate long-term outcomes.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"39 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472816","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":"Patient characteristics and perioperative outcomes in the Bypass Equipoise Sleeve Trial (BEST) compared to general metabolic bariatric practice in Sweden.","authors":"Suzanne Hedberg,Erik Stenberg,Johanna Österberg,Ellen Andersson,Markku Peltonen,Erik Näslund,Martin Neovius,Anders Thorell,Torsten Olbers,Johan Ottosson, ","doi":"10.1093/bjs/znaf187","DOIUrl":"https://doi.org/10.1093/bjs/znaf187","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"26 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261457","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}
Kajsa Sjöholm,Markku Peltonen,Peter Jacobson,Johanna C Andersson-Assarsson,Sofie Ahlin,Lucas Adméus,Ida Arnetorp,My Engström,Magdalena Taube,Lena M S Carlsson,Per-Arne Svensson
BACKGROUNDA body of evidence supports a link between metabolic bariatric surgery (MBS) and alcohol use disorder (AUD), while the possible contribution to alcohol-related mortality remains unclear. The aim of this study was to examine the association between MBS and the risk of AUD and alcohol-related mortality over up to 35 years.METHODSThe Swedish Obese Subjects (SOS) study enrolled 2007 participants with severe obesity who underwent MBS and 2040 matched controls (median follow-up 25.2 years). Patients in the surgery group underwent gastric bypass (GBP; 266 patients), gastric banding (376 patients), or vertical banded gastroplasty (VBG; 1365 patients). The matched controls received the customary treatment for severe obesity at their primary healthcare centres. Data on AUD diagnoses and alcohol-related mortality were captured from the Swedish National Patient Register and the Swedish Cause of Death Register respectively.RESULTSDuring long-term follow-up, a significant difference in the incidence of AUD was found across surgery groups (log rank P < 0.001). Patients who underwent GBP exhibited the highest AUD risk (adjusted HR (HRadj) 5.07 (95% c.i. 3.11 to 8.25); P < 0.001), followed by patients who underwent VBG (HRadj 2.28 (95% c.i. 1.56 to 3.34); P < 0.001) and patients who underwent gastric banding (HRadj 2.34 (95% c.i. 1.37 to 4.01); P = 0.002), compared with usual obesity care. Alcohol-related mortality was significantly elevated after GBP (adjusted sub-HR (sub-HRadj) 6.18 (95% c.i. 2.48 to 15.40); P < 0.001) and VBG (sub-HRadj 3.56 (95% c.i. 1.79 to 7.08); P < 0.001) compared with usual obesity care. Mortality after gastric banding was also elevated, but did not reach statistical significance (sub-HRadj 2.52 (95% c.i. 0.89 to 7.15); P = 0.082).CONCLUSIONEffective management of alcohol-related complications in MBS patients requires preoperative risk assessment, postoperative monitoring, and access to targeted interventions for AUD.
{"title":"Alcohol use disorder and alcohol-related mortality after metabolic bariatric surgery: prospective controlled cohort study.","authors":"Kajsa Sjöholm,Markku Peltonen,Peter Jacobson,Johanna C Andersson-Assarsson,Sofie Ahlin,Lucas Adméus,Ida Arnetorp,My Engström,Magdalena Taube,Lena M S Carlsson,Per-Arne Svensson","doi":"10.1093/bjs/znaf211","DOIUrl":"https://doi.org/10.1093/bjs/znaf211","url":null,"abstract":"BACKGROUNDA body of evidence supports a link between metabolic bariatric surgery (MBS) and alcohol use disorder (AUD), while the possible contribution to alcohol-related mortality remains unclear. The aim of this study was to examine the association between MBS and the risk of AUD and alcohol-related mortality over up to 35 years.METHODSThe Swedish Obese Subjects (SOS) study enrolled 2007 participants with severe obesity who underwent MBS and 2040 matched controls (median follow-up 25.2 years). Patients in the surgery group underwent gastric bypass (GBP; 266 patients), gastric banding (376 patients), or vertical banded gastroplasty (VBG; 1365 patients). The matched controls received the customary treatment for severe obesity at their primary healthcare centres. Data on AUD diagnoses and alcohol-related mortality were captured from the Swedish National Patient Register and the Swedish Cause of Death Register respectively.RESULTSDuring long-term follow-up, a significant difference in the incidence of AUD was found across surgery groups (log rank P < 0.001). Patients who underwent GBP exhibited the highest AUD risk (adjusted HR (HRadj) 5.07 (95% c.i. 3.11 to 8.25); P < 0.001), followed by patients who underwent VBG (HRadj 2.28 (95% c.i. 1.56 to 3.34); P < 0.001) and patients who underwent gastric banding (HRadj 2.34 (95% c.i. 1.37 to 4.01); P = 0.002), compared with usual obesity care. Alcohol-related mortality was significantly elevated after GBP (adjusted sub-HR (sub-HRadj) 6.18 (95% c.i. 2.48 to 15.40); P < 0.001) and VBG (sub-HRadj 3.56 (95% c.i. 1.79 to 7.08); P < 0.001) compared with usual obesity care. Mortality after gastric banding was also elevated, but did not reach statistical significance (sub-HRadj 2.52 (95% c.i. 0.89 to 7.15); P = 0.082).CONCLUSIONEffective management of alcohol-related complications in MBS patients requires preoperative risk assessment, postoperative monitoring, and access to targeted interventions for AUD.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"158 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246913","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":"Acute pancreatitis national audit of practice: a national prospective audit of acute pancreatitis in the era of GLP-1 agonists-the PANDORA audit protocol.","authors":" ","doi":"10.1093/bjs/znaf214","DOIUrl":"https://doi.org/10.1093/bjs/znaf214","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"115 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261504","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}
Connor P Boyle,James Crichton,Alessandro Sgrò,Sarah H Michael,Stephen J Wigmore,Richard J E Skipworth,Steven Yule
{"title":"'Play to the conditions': optimizing the operating theatre environment through lessons from elite performance domains.","authors":"Connor P Boyle,James Crichton,Alessandro Sgrò,Sarah H Michael,Stephen J Wigmore,Richard J E Skipworth,Steven Yule","doi":"10.1093/bjs/znaf181","DOIUrl":"https://doi.org/10.1093/bjs/znaf181","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"11 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296201","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}
Ricardo V Cohen,Mohammad Kermansaravi,Randy Levinson,Muffazal Lakdawala,Chetan Parmar,Yosuke Seki,Gerhard Prager,Paulina Salminen,
{"title":"International Federation for the Surgery and Other Therapies for Obesity (IFSO) global consensus recommendations for optimizing outcomes after sleeve gastrectomy.","authors":"Ricardo V Cohen,Mohammad Kermansaravi,Randy Levinson,Muffazal Lakdawala,Chetan Parmar,Yosuke Seki,Gerhard Prager,Paulina Salminen, ","doi":"10.1093/bjs/znaf188","DOIUrl":"https://doi.org/10.1093/bjs/znaf188","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"64 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296203","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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