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Perioperative glucocorticoids: friend or foe? 围手术期糖皮质激素:朋友还是敌人?
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae232
Henrik Kehlet
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引用次数: 0
Acute diabetic foot disease. 急性糖尿病足病。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae226
Amy Jones, Robert Hinchliffe
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引用次数: 0
Baseline MRI predictors of successful organ preservation in the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial. 直肠腺癌器官保留(OPRA)试验中成功保留器官的磁共振成像基线预测因素。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae246
Hannah Williams, Jonathan B Yuval, Floris S Verheij, Joao Miranda, Sabrina T Lin, Dana M Omer, Li-Xuan Qin, Marc J Gollub, Tae-Hyung Kim, Julio Garcia-Aguilar

Background: Prospective randomized trials have not yet identified baseline features predictive of organ preservation in locally advanced rectal cancers treated with total neoadjuvant therapy and a selective watch-and-wait strategy.

Methods: This was a secondary analysis of the OPRA trial, which randomized patients with stage II-III rectal adenocarcinoma to receive either induction or consolidation total neoadjuvant therapy. Patients were recommended for total mesorectal excision, or watch and wait based on clinical response at 8 ± 4 weeks after completing treatment. Standardized baseline clinical and radiological variables were collected prospectively. Survival outcomes, including total mesorectal excision-free survival, disease-free survival, and overall survival, were assessed by intention-to-treat analysis. Cox proportional hazards models were used to evaluate associations between baseline variables and survival outcomes.

Results: Of the 324 patients randomized for the OPRA trial, 38 (11.7%) had cT4 tumours, 230 (71.0%) cN-positive disease, 101 (32.5%) mesorectal fascia involvement, and 64 (19.8%) extramural venous invasion. Several baseline features were independently associated with recommendation for total mesorectal excision on multivariable analysis: nodal disease (HR 1.66, 95% c.i. 1.12 to 2.48), extramural venous invasion (HR 1.57, 1.07 to 2.29), mesorectal fascia involvement (HR 1.45, 1.01 to 2.09), and tumour length (HR 1.11, 1.00 to 1.22). Of these, nodal disease (HR 2.02, 1.15 to 3.53) and mesorectal fascia involvement (HR 2.02, 1.26 to 3.26) also predicted worse disease-free survival. Age (HR 1.03, 1.00 to 1.06) was associated with overall survival.

Conclusion: Baseline MRI features, including nodal disease, extramural venous invasion, mesorectal fascia involvement, and tumour length, independently predict the likelihood of organ preservation after completion of total neoadjuvant therapy. Mesorectal fascia involvement and nodal disease are associated with disease-free survival.

背景:前瞻性随机试验尚未确定采用全新药辅助治疗和选择性观察等待策略的局部晚期直肠癌患者的器官保留基线特征:前瞻性随机试验尚未确定局部晚期直肠癌患者接受全新药辅助治疗和选择性观察-等待策略后器官保留的预测基线特征:本研究是对OPRA试验的二次分析,该试验将II-III期直肠腺癌患者随机分为诱导性或巩固性全新辅助治疗两种。根据患者在完成治疗后8±4周的临床反应,推荐患者接受全直肠系膜切除术或观察等待。前瞻性地收集了标准化的基线临床和放射学变量。通过意向治疗分析评估生存结果,包括无直肠系膜全切除生存率、无病生存率和总生存率。采用Cox比例危险模型评估基线变量与生存结果之间的关系:在324名随机参加OPRA试验的患者中,38人(11.7%)患有cT4肿瘤,230人(71.0%)患有cN阳性疾病,101人(32.5%)直肠中筋膜受累,64人(19.8%)患有壁外静脉侵犯。在多变量分析中,有几项基线特征与建议进行全直肠系膜切除术独立相关:结节病(HR 1.66,95% 置信区间为 1.12 至 2.48)、壁外静脉侵犯(HR 1.57,1.07 至 2.29)、直肠系膜筋膜受累(HR 1.45,1.01 至 2.09)和肿瘤长度(HR 1.11,1.00 至 1.22)。其中,结节病(HR 2.02,1.15 至 3.53)和直肠间筋膜受累(HR 2.02,1.26 至 3.26)也预示着较差的无病生存率。年龄(HR 1.03,1.00 至 1.06)与总生存率相关:结论:MRI基线特征,包括结节病、壁外静脉侵犯、直肠间筋膜受累和肿瘤长度,可独立预测完成全部新辅助治疗后保留器官的可能性。直肠间筋膜受累和结节病与无病生存率相关。
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引用次数: 0
Effect of tailoring biliopancreatic limb length based on total small bowel length versus standard limb length in one anastomosis gastric bypass: 1-year outcomes of the TAILOR randomized clinical superiority trial. 在单吻合胃旁路术中,根据小肠总长度定制胆胰管肢体长度与标准肢体长度的对比效果:TAILOR 随机临床优越性试验的 1 年结果。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae219
Nienke Slagter, Lindsy van der Laan, Loek J M de Heide, Ewoud H Jutte, Mirjam A Kaijser, Stefan L Damen, André P van Beek, Marloes Emous

Background: Tailoring the biliopancreatic limb length in one anastomosis gastric bypass is proposed as beneficial in retrospective studies, yet randomized trials are lacking. The aim of this double-blind, single-centre RCT was to ascertain whether tailoring biliopancreatic limb length based on total small bowel length (TSBL) results in superior outcomes after one anastomosis gastric bypass compared with a fixed 150 cm biliopancreatic limb length.

Methods: Eligible patients, meeting International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) criteria for metabolic bariatric surgery, scheduled for primary one anastomosis gastric bypass surgery, and willing to be randomized, underwent TSBL measurement during surgery. When TSBL measurement was feasible, patients were randomly assigned to a standard 150 cm biliopancreatic limb length or a tailored biliopancreatic limb based on TSBL: TSBL less than 500 cm, biliopancreatic limb 150 cm; TSBL 500-700 cm, biliopancreatic limb 180 cm; and TSBL greater than 700 cm, biliopancreatic limb 210 cm. The primary outcome was percentage total weight loss at 5 years.

Results: Between September 2020 and August 2022, 212 patients were randomized into the standard biliopancreatic limb group (105 patients) or the tailored biliopancreatic limb group (107 patients). The mean(s.d.) TSBL was 657(128) cm (range 295-1020 cm). In the tailored group, 150, 180, and 210 cm biliopancreatic limb lengths were applied to 8.4%, 53.3%, and 38.3% of patients respectively. The mean(s.d.) 1-year percentage total weight loss was 32.8(6.9)% in the standard group and 33.1(6.2)% in the tailored group (P = 0.787). Nutritional deficiencies and short-term complications showed no significant differences.

Conclusion: Tailoring biliopancreatic limb length based on TSBL is safe and feasible. One year after surgery, it is not superior to a standard biliopancreatic limb length of 150 cm in terms of percentage total weight loss.

Registration number: Dutch Trial Register, NL7945.

背景:回顾性研究认为,在一次吻合胃旁路术中定制胆胰管肢体长度是有益的,但目前还缺乏随机试验。这项双盲、单中心 RCT 的目的是确定根据小肠总长度(TSBL)定制胆胰管肢体长度与固定的 150 厘米胆胰管肢体长度相比,是否能在一次吻合胃旁路术后获得更好的疗效:方法:符合国际肥胖和代谢紊乱外科联合会(IFSO)代谢减肥手术标准、计划接受一次吻合胃旁路手术并愿意接受随机分组的合格患者在手术期间接受 TSBL 测量。如果可以进行TSBL测量,患者将被随机分配到标准的150厘米胆胰管肢体长度或根据TSBL定制的胆胰管肢体:TSBL小于500厘米,胆胰管肢体长度为150厘米;TSBL为500-700厘米,胆胰管肢体长度为180厘米;TSBL大于700厘米,胆胰管肢体长度为210厘米。主要结果是5年后总重量下降的百分比:2020年9月至2022年8月,212名患者被随机分为标准胆胰管肢体组(105名)或定制胆胰管肢体组(107名)。TSBL的平均值(s.d.)为657(128)厘米(范围为295-1020厘米)。在定制组中,分别有8.4%、53.3%和38.3%的患者采用了150、180和210厘米的胆胰管肢体长度。标准组 1 年总重量下降的平均百分比(s.d.)为 32.8(6.9)%,定制组为 33.1(6.2)%(P = 0.787)。营养缺乏和短期并发症无明显差异:结论:根据TSBL定制胆胰管肢体长度是安全可行的。结论:根据 TSBL 定制胆胰管肢体长度是安全可行的,术后一年,就总重量减少的百分比而言,它并不比 150 厘米的标准胆胰管肢体长度更有优势:注册编号:荷兰试验注册,NL7945。
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引用次数: 0
Emergency care of metabolic bariatric surgery patients. 代谢性减肥手术患者的紧急护理。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae233
Roxanna Zakeri,Ellen Andersson,Cynthia M Borg,Ronald S L Liem
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引用次数: 0
Disease-specific survival outcomes for patients after locoregional treatment for ductal carcinoma in situ: observational cohort study. 导管原位癌局部治疗后患者的疾病特异性生存结果:观察性队列研究。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae198
Sabrina M Wang, Yan Li, Amanda Nash, Yi Ren, Samantha M Thomas, Amanda B Francescatti, Anne Barber, Thomas Lynch, Elizabeth S Frank, Lars J Grimm, Alastair M Thompson, Ann H Partridge, Terry Hyslop, E Shelley Hwang, Marc D Ryser

Background: Breast-conserving surgery alone, breast-conserving surgery with adjuvant radiation treatment, and mastectomy are guideline-concordant treatments for ductal carcinoma in situ. The aim of this study was to compare survival outcomes between these treatment options.

Methods: A stratified random sample of patients diagnosed with pure ductal carcinoma in situ between 2008 and 2014 was selected from 1330 sites in the USA. Data on diagnosis, treatment, and follow-up were abstracted by local cancer registrars. Population-averaged marginal estimates of disease-specific survival and overall survival for breast-conserving surgery alone, breast-conserving surgery with radiation treatment, and mastectomy were obtained by combining sampling and overlap weights.

Results: A total of 18 442 women were included, with a median follow-up of 67.8 (interquartile range 46.1-93.5) months. A total of 35 women died from breast cancer, at a median age of 62 (interquartile range 50-74) years. Population-averaged 8-year rates of disease-specific survival were 99.6% or higher for all treatment groups, with no significant differences between groups (breast-conserving surgery alone versus breast-conserving surgery with radiation treatment, HR 1.19 (95% c.i. 0.29 to 4.85); and mastectomy versus breast-conserving surgery with radiation treatment, HR 1.74 (95% c.i. 0.53 to 5.72). There was no difference in overall survival between the patients who underwent a mastectomy and the patients who underwent breast-conserving surgery with radiation treatment (HR 1.09 (95% c.i. 0.83 to 1.43)). Patients who underwent breast-conserving surgery alone had lower overall survival compared with the patients who underwent breast-conserving surgery with radiation treatment (HR 1.29 (95% c.i. 1.00 to 1.67)). This survival difference vanished for all but one subgroup, namely patients less than 65 years (HR 1.86 (95% c.i. 1.15 to 3.00)).

Conclusion: There was no statistically significant difference in disease-specific survival between women operated with breast-conserving surgery alone, breast-conserving surgery with radiation treatment, or mastectomy for ductal carcinoma in situ. Given the low absolute risk of disease-specific mortality, these results provide confidence in offering individualized locoregional treatment without fear of compromising survival.

背景:单纯保乳手术、保乳手术加辅助放射治疗以及乳房切除术是乳腺导管原位癌的指导性一致治疗方法。本研究旨在比较这些治疗方案的生存结果:方法:从美国 1330 个医疗机构中选取 2008 年至 2014 年期间确诊为纯导管原位癌的患者作为分层随机样本。诊断、治疗和随访数据由当地癌症登记员抽取。结合抽样和重叠权重,得出了单纯保乳手术、保乳手术加放射治疗和乳房切除术的疾病特异性生存率和总生存率的人群平均边际估计值:研究共纳入了 18 442 名妇女,中位随访时间为 67.8 个月(四分位间范围为 46.1-93.5 个月)。共有 35 名妇女死于乳腺癌,中位年龄为 62 岁(四分位数间距为 50-74)。所有治疗组的人群平均 8 年疾病特异性生存率均在 99.6% 或以上,组间无显著差异(单纯保乳手术与保乳手术加放射治疗相比,HR 为 1.19(95% 置信区间为 0.29 至 4.85);乳房切除术与保乳手术加放射治疗相比,HR 为 1.74(95% 置信区间为 0.53 至 5.72)。接受乳房切除术的患者与接受放射治疗的保乳手术患者的总生存率没有差异(HR 1.09(95% 置信区间:0.83 至 1.43))。与接受放射治疗的保乳手术患者相比,单纯接受保乳手术的患者总生存率较低(HR 1.29(95% 置信区间:1.00 至 1.67))。除了一个亚组,即小于65岁的患者(HR 1.86 (95% c.i. 1.15 to 3.00))外,其他所有亚组的生存率差异都消失了:结论:单纯保乳手术、保乳手术加放射治疗或乳腺切除术治疗乳腺导管原位癌的妇女在疾病特异性生存率方面没有明显的统计学差异。鉴于疾病特异性死亡率的绝对风险较低,这些结果为提供个体化的局部治疗提供了信心,而不必担心影响生存率。
{"title":"Disease-specific survival outcomes for patients after locoregional treatment for ductal carcinoma in situ: observational cohort study.","authors":"Sabrina M Wang, Yan Li, Amanda Nash, Yi Ren, Samantha M Thomas, Amanda B Francescatti, Anne Barber, Thomas Lynch, Elizabeth S Frank, Lars J Grimm, Alastair M Thompson, Ann H Partridge, Terry Hyslop, E Shelley Hwang, Marc D Ryser","doi":"10.1093/bjs/znae198","DOIUrl":"10.1093/bjs/znae198","url":null,"abstract":"<p><strong>Background: </strong>Breast-conserving surgery alone, breast-conserving surgery with adjuvant radiation treatment, and mastectomy are guideline-concordant treatments for ductal carcinoma in situ. The aim of this study was to compare survival outcomes between these treatment options.</p><p><strong>Methods: </strong>A stratified random sample of patients diagnosed with pure ductal carcinoma in situ between 2008 and 2014 was selected from 1330 sites in the USA. Data on diagnosis, treatment, and follow-up were abstracted by local cancer registrars. Population-averaged marginal estimates of disease-specific survival and overall survival for breast-conserving surgery alone, breast-conserving surgery with radiation treatment, and mastectomy were obtained by combining sampling and overlap weights.</p><p><strong>Results: </strong>A total of 18 442 women were included, with a median follow-up of 67.8 (interquartile range 46.1-93.5) months. A total of 35 women died from breast cancer, at a median age of 62 (interquartile range 50-74) years. Population-averaged 8-year rates of disease-specific survival were 99.6% or higher for all treatment groups, with no significant differences between groups (breast-conserving surgery alone versus breast-conserving surgery with radiation treatment, HR 1.19 (95% c.i. 0.29 to 4.85); and mastectomy versus breast-conserving surgery with radiation treatment, HR 1.74 (95% c.i. 0.53 to 5.72). There was no difference in overall survival between the patients who underwent a mastectomy and the patients who underwent breast-conserving surgery with radiation treatment (HR 1.09 (95% c.i. 0.83 to 1.43)). Patients who underwent breast-conserving surgery alone had lower overall survival compared with the patients who underwent breast-conserving surgery with radiation treatment (HR 1.29 (95% c.i. 1.00 to 1.67)). This survival difference vanished for all but one subgroup, namely patients less than 65 years (HR 1.86 (95% c.i. 1.15 to 3.00)).</p><p><strong>Conclusion: </strong>There was no statistically significant difference in disease-specific survival between women operated with breast-conserving surgery alone, breast-conserving surgery with radiation treatment, or mastectomy for ductal carcinoma in situ. Given the low absolute risk of disease-specific mortality, these results provide confidence in offering individualized locoregional treatment without fear of compromising survival.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142102483","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
Neoadjuvant therapy with peptide receptor radionuclide therapy for pancreatic neuroendocrine tumours. 胰腺神经内分泌肿瘤的肽受体放射性核素新辅助疗法。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae183
Julie Hallet, Kjetil Søreide
{"title":"Neoadjuvant therapy with peptide receptor radionuclide therapy for pancreatic neuroendocrine tumours.","authors":"Julie Hallet, Kjetil Søreide","doi":"10.1093/bjs/znae183","DOIUrl":"10.1093/bjs/znae183","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11364144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142102529","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
Bowel cleansing, dysbiosis, and postoperative infection: the dots are starting to connect. 肠道清洁、菌群失调和术后感染:这些点开始联系起来。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-30 DOI: 10.1093/bjs/znae207
John C Alverdy
{"title":"Bowel cleansing, dysbiosis, and postoperative infection: the dots are starting to connect.","authors":"John C Alverdy","doi":"10.1093/bjs/znae207","DOIUrl":"https://doi.org/10.1093/bjs/znae207","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118510","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
Inequalities for women diagnosed with distal arch and descending thoracic aortic aneurysms: results from the Effective Treatments for Thoracic Aortic Aneurysms (ETTAA) cohort study. 被诊断出患有远端拱形和降主动脉瘤的女性的不平等:胸主动脉瘤有效治疗(ETTAA)队列研究的结果。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae185
Anna L Pouncey, Dhvni Patel, Carol Freeman, Priya Sastry, Colin Bicknell, Stephen R Large, Linda D Sharples

Background: Women with thoracic aortic aneurysms within the arch or descending thoracic aorta have poorer survival than men. Sex differences in relative thoracic aortic aneurysm size may account for some of the discrepancy. The aim of this study was to explore whether basing clinical management on aneurysm size index (maximum aneurysm diameter/body surface area) rather than aneurysm size can restore equality of survival by sex.

Methods: The Effective Treatments for Thoracic Aortic Aneurysms (ETTAA; ISRCTN04044627) study was a prospective, observational cohort study. Adults referred to National Health Service hospitals in England with new/existing arch or descending thoracic aorta aneurysms greater than or equal to 4 cm in diameter were followed from March 2014 to March 2022. Baseline characteristics and survival to intervention and overall were compared for men and women. Survival models were used to assess the association between all-cause survival and sex, with and without adjustment for aneurysm diameter or aneurysm size index.

Results: A total of 886 thoracic aortic aneurysm patients were recruited: 321 (36.2%) women and 565 (63.8%) men. The mean(s.d.) aneurysm diameter was the same for women and men (5.7(1.1) versus 5.7(1.2) cm respectively; P = 0.751), but the mean(s.d.) aneurysm size index was greater for women than for men (3.32(0.80) versus 2.83(0.63) respectively; P < 0.001). Women had significantly worse survival without intervention: 110 (34.3%) women and 135 (23.9%) men (log rank test, P < 0.001). All-cause mortality remained greater for women after adjustment for diameter (HR 1.65 (95% c.i. 1.35 to 2.02); P < 0.001), but was attenuated after adjustment for aneurysm size index (HR 1.11 (95% c.i. 0.89 to 1.38); P = 0.359). Similar results were found for all follow-up, with or without intervention, and findings were consistent for descending thoracic aorta aneurysms alone.

Conclusion: Guidelines for referral to specialist services should consider including aneurysm size index rather than diameter to reduce inequity due to patient sex.

背景:患有胸主动脉弓或降主动脉内胸主动脉瘤的女性存活率低于男性。胸主动脉瘤相对大小的性别差异可能是造成这种差异的部分原因。本研究旨在探讨根据动脉瘤大小指数(动脉瘤最大直径/体表面积)而非动脉瘤大小进行临床管理是否能恢复性别生存率平等:胸主动脉瘤的有效治疗(ETTAA;ISRCTN04044627)研究是一项前瞻性观察队列研究。2014年3月至2022年3月期间,对转诊至英格兰国民健康服务医院、患有直径大于或等于4厘米的新发/存在的弓形或降主动脉瘤的成人进行了随访。比较了男性和女性的基线特征、干预后存活率和总存活率。在对动脉瘤直径或动脉瘤大小指数进行调整或未进行调整的情况下,使用生存模型评估全因生存率与性别之间的关系:结果:共招募了 886 名胸主动脉瘤患者:其中女性 321 人(36.2%),男性 565 人(63.8%)。女性和男性动脉瘤的平均(s.d.)直径相同(分别为 5.7(1.1) cm 对 5.7(1.2) cm;P = 0.751),但女性动脉瘤的平均(s.d.)大小指数大于男性(分别为 3.32(0.80) cm 对 2.83(0.63) cm;P < 0.001)。女性在未接受干预的情况下存活率明显较低:女性为 110 人(34.3%),男性为 135 人(23.9%)(对数秩检验,P < 0.001)。根据直径进行调整后,女性的全因死亡率仍然更高(HR 1.65(95% 置信区间:1.35 至 2.02);P < 0.001),但根据动脉瘤大小指数进行调整后,女性的全因死亡率有所降低(HR 1.11(95% 置信区间:0.89 至 1.38);P = 0.359)。无论是否进行干预,所有随访结果相似,仅降主动脉瘤的随访结果一致:结论:专科服务转诊指南应考虑纳入动脉瘤大小指数而非直径,以减少因患者性别造成的不平等。
{"title":"Inequalities for women diagnosed with distal arch and descending thoracic aortic aneurysms: results from the Effective Treatments for Thoracic Aortic Aneurysms (ETTAA) cohort study.","authors":"Anna L Pouncey, Dhvni Patel, Carol Freeman, Priya Sastry, Colin Bicknell, Stephen R Large, Linda D Sharples","doi":"10.1093/bjs/znae185","DOIUrl":"10.1093/bjs/znae185","url":null,"abstract":"<p><strong>Background: </strong>Women with thoracic aortic aneurysms within the arch or descending thoracic aorta have poorer survival than men. Sex differences in relative thoracic aortic aneurysm size may account for some of the discrepancy. The aim of this study was to explore whether basing clinical management on aneurysm size index (maximum aneurysm diameter/body surface area) rather than aneurysm size can restore equality of survival by sex.</p><p><strong>Methods: </strong>The Effective Treatments for Thoracic Aortic Aneurysms (ETTAA; ISRCTN04044627) study was a prospective, observational cohort study. Adults referred to National Health Service hospitals in England with new/existing arch or descending thoracic aorta aneurysms greater than or equal to 4 cm in diameter were followed from March 2014 to March 2022. Baseline characteristics and survival to intervention and overall were compared for men and women. Survival models were used to assess the association between all-cause survival and sex, with and without adjustment for aneurysm diameter or aneurysm size index.</p><p><strong>Results: </strong>A total of 886 thoracic aortic aneurysm patients were recruited: 321 (36.2%) women and 565 (63.8%) men. The mean(s.d.) aneurysm diameter was the same for women and men (5.7(1.1) versus 5.7(1.2) cm respectively; P = 0.751), but the mean(s.d.) aneurysm size index was greater for women than for men (3.32(0.80) versus 2.83(0.63) respectively; P < 0.001). Women had significantly worse survival without intervention: 110 (34.3%) women and 135 (23.9%) men (log rank test, P < 0.001). All-cause mortality remained greater for women after adjustment for diameter (HR 1.65 (95% c.i. 1.35 to 2.02); P < 0.001), but was attenuated after adjustment for aneurysm size index (HR 1.11 (95% c.i. 0.89 to 1.38); P = 0.359). Similar results were found for all follow-up, with or without intervention, and findings were consistent for descending thoracic aorta aneurysms alone.</p><p><strong>Conclusion: </strong>Guidelines for referral to specialist services should consider including aneurysm size index rather than diameter to reduce inequity due to patient sex.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 8","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873662","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
European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. 欧洲内分泌外科医生学会(ESES)关于晚期甲状腺癌:定义和管理的共识声明。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae199
Marco Raffaelli, Nikolaos Voloudakis, Marcin Barczynski, Katrin Brauckhoff, Cosimo Durante, Joaquin Gomez-Ramirez, Ioannis Koutelidakis, Kerstin Lorenz, Ozer Makay, Gabriele Materazzi, Rumen Pandev, Gregory W Randolph, Neil Tolley, Menno Vriens, Thomas Musholt
{"title":"European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management.","authors":"Marco Raffaelli, Nikolaos Voloudakis, Marcin Barczynski, Katrin Brauckhoff, Cosimo Durante, Joaquin Gomez-Ramirez, Ioannis Koutelidakis, Kerstin Lorenz, Ozer Makay, Gabriele Materazzi, Rumen Pandev, Gregory W Randolph, Neil Tolley, Menno Vriens, Thomas Musholt","doi":"10.1093/bjs/znae199","DOIUrl":"10.1093/bjs/znae199","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 8","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141998995","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
期刊
British Journal of Surgery
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