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Corrigendum: Defining standards and core outcomes for clinical trials in prehabilitation for colorectal surgery (DiSCO): modified Delphi methodology to achieve patient and healthcare professional consensus. 更正:确定结直肠手术前康复(DiSCO)临床试验的标准和核心结果:改良德尔菲法达成患者和医护人员共识。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae201
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引用次数: 0
Role of Lugol solution before total thyroidectomy for Graves' disease: randomized clinical trial. 巴塞杜氏病甲状腺全切除术前使用鲁戈尔溶液的作用:随机临床试验。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae196
Donatella Schiavone, Filippo Crimì, Giulio Cabrelle, Gianmaria Pennelli, Diana Sacchi, Caterina Mian, Francesca Torresan, Maurizio Iacobone

Background: Lugol solution is often administered to patients with Graves' disease before surgery. The aim is to reduce thyroid vascularization and surgical morbidity, but its real effectiveness remains controversial. The present study was designed to evaluate the effects of preoperative Lugol solution on thyroid vascularization and surgical morbidity in patients with Graves' disease undergoing total thyroidectomy.

Methods: Fifty-six patients undergoing total thyroidectomy for Graves' disease were randomly assigned to receive 7 days of Lugol treatment (Lugol+ group, 29) or no Lugol treatment (LS- group, 27) before surgery in this single-centre and single-blinded trial. Preoperative hormone and colour Doppler ultrasonographic data for assessing thyroid vascularization were collected 8 days before surgery (T0) and on the day of surgery (T1). The primary outcome was intraoperative and postoperative blood loss. Secondary outcomes included duration of surgery, thyroid function, morbidity, vascularization, and microvessel density at final pathology.

Results: No differences in demographic, preoperative hormone or ultrasonographic data were found between LS+ and LS- groups at T0. At T1, free tri-iodothyronine (FT3) and free thyroxine (FT4) levels were significantly reduced compared with T0 values in the LS+ group, whereas no such variation was observed in the LS- group. No differences between T0 and T1 were found for ultrasonographic vascularization in either group, nor did the histological findings differ. There were no significant differences between the LS+ and LS- groups concerning intraoperative/postoperative blood loss (median 80.5 versus 94 ml respectively), duration of surgery (75 min in both groups) or postoperative morbidity.

Conclusion: Lugol solution significantly reduces FT3 and FT4 levels in patients undergoing surgery for Graves' disease, but does not decrease intraoperative/postoperative blood loss, thyroid vascularization, duration of surgery or postoperative morbidity.

Registration number: NCT05784792 (https://www.clinicaltrials.gov).

背景:巴塞杜氏病患者在手术前通常会使用卢戈溶液。其目的是减少甲状腺血管扩张和手术发病率,但其实际效果仍存在争议。本研究旨在评估术前使用卢戈溶液对接受全甲状腺切除术的巴塞杜氏病患者甲状腺血管化和手术发病率的影响:在这项单中心、单盲试验中,56名接受甲状腺全切除术的巴塞杜氏病患者被随机分配到术前接受7天鲁戈尔治疗(鲁戈尔+组,29人)或不接受鲁戈尔治疗(LS-组,27人)。手术前 8 天(T0)和手术当天(T1)收集术前激素和用于评估甲状腺血管的彩色多普勒超声数据。主要结果是术中和术后失血量。次要结果包括手术时间、甲状腺功能、发病率、血管化程度以及最终病理检查时的微血管密度:结果:LS+组和LS-组在T0时的人口统计学、术前激素或超声数据均无差异。T1时,与T0值相比,LS+组游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平明显降低,而LS-组无此变化。两组患者在 T0 和 T1 期间的超声血管造影结果均无差异,组织学结果也无差异。LS+组和LS-组在术中/术后失血量(中位数分别为80.5毫升和94毫升)、手术时间(两组均为75分钟)或术后发病率方面均无明显差异:结论:卢戈溶液可明显降低接受手术治疗巴塞杜氏病患者的FT3和FT4水平,但不会减少术中/术后失血量、甲状腺血管形成、手术持续时间或术后发病率:NCT05784792 (https://www.clinicaltrials.gov)。
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引用次数: 0
Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study. 门静脉栓塞术后结直肠肝转移的腹腔镜与开腹右肝切除术:国际多中心研究。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae181
Emre Bozkurt, Jasper P Sijberden, Serena Langella, Federica Cipriani, Francesc Collado-Roura, Victoria Morrison-Jones, Burak Görgec, Gabriel Zozaya, Jacopo Lanari, Davit Aghayan, Celine De Meyere, David Fuks, Giuseppe Zimmiti, Benedetto Ielpo, Mikhail Efanov, Robert P Sutcliffe, Nadia Russolillo, Miquel Gomez-Artacho, Francesca Ratti, Mathieu D'Hondt, Bjørn Edwin, Umberto Cillo, Fernando Rotellar, Marc G Besselink, John N Primrose, Santi Lopez-Ben, Luca A Aldrighetti, Alessandro Ferrero, Mohammad Abu Hilal

Background: Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization.

Methods: This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020. The perioperative and oncological outcomes for patients who underwent laparoscopic and open approaches were compared using propensity score matching.

Results: Of 338 patients, 84 patients underwent a laparoscopic procedure and 254 patients underwent an open procedure. Patients in the laparoscopic group less often underwent extended right hepatectomy (18% versus 34.6% (P = 0.004)), procedures in the setting of a two-stage hepatectomy (42% versus 65% (P < 0.001)), and major concurrent procedures (4% versus 16.1% (P = 0.003)). After propensity score matching, 78 patients remained in each group. The laparoscopic approach was associated with longer operating and Pringle times (330 versus 258.5 min (P < 0.001) and 65 versus 30 min (P = 0.001) respectively) and a shorter length of stay (7 versus 8 days (P = 0.011)). The R0 resection rate was not different (71% for the laparoscopic approach versus 60% for the open approach (P = 0.230)). The median disease-free survival was 12 (95% c.i. 10 to 20) months for the laparoscopic approach versus 20 (95% c.i. 13 to 31) months for the open approach (P = 0.145). The median overall survival was 28 (95% c.i. 22 to 48) months for the laparoscopic approach versus 42 (95% c.i. 35 to 52) months for the open approach (P = 0.614).

Conclusion: The advantages of a laparoscopic over an open approach for (extended) right hepatectomy for colorectal liver metastases after portal vein embolization are limited.

背景:腹腔镜肝脏手术越来越多地用于更具挑战性的手术。本研究旨在评估门静脉栓塞术后腹腔镜右肝切除术治疗结直肠肝转移瘤的可行性和肿瘤安全性:这是一项国际多中心回顾性研究,研究对象是2004年至2020年间接受门静脉栓塞术后开腹或腹腔镜右肝切除术和右肝扩大切除术的结直肠肝转移患者。采用倾向评分匹配法比较了腹腔镜和开腹手术患者的围手术期和肿瘤学结果:在 338 名患者中,84 名患者接受了腹腔镜手术,254 名患者接受了开腹手术。腹腔镜组患者较少接受扩大右肝切除术(18% 对 34.6% (P = 0.004))、两期肝切除术(42% 对 65% (P < 0.001))和主要并发症手术(4% 对 16.1% (P = 0.003))。经过倾向评分匹配后,每组仍有78名患者。腹腔镜方法的手术时间和普林格尔时间更长(分别为330分钟对258.5分钟(P < 0.001)和65分钟对30分钟(P = 0.001)),住院时间更短(7天对8天(P = 0.011))。R0切除率没有差异(腹腔镜方法为71%,开腹方法为60%(P = 0.230))。腹腔镜方法的中位无病生存期为12个月(95% c.i.10至20个月),而开腹方法为20个月(95% c.i.13至31个月)(P = 0.145)。腹腔镜方法的中位总生存期为28(95% c.i.22至48)个月,而开腹方法为42(95% c.i.35至52)个月(P = 0.614):结论:在门静脉栓塞术后进行结直肠肝转移(扩大)右肝切除术时,腹腔镜方法比开腹方法的优势有限。
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引用次数: 0
Management of subcutaneous abscesses: prospective cross-sectional study (MAGIC). 皮下脓肿的治疗:前瞻性横断面研究(MAGIC)。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae162
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引用次数: 0
Author response to: Comment on: Total neoadjuvant therapy versus standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials. 作者回复:评论:治疗局部晚期直肠癌的全新术式治疗与标准新术式治疗策略:随机临床试验网络荟萃分析。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae211
Mark Donnelly, Odhrán K Ryan, Éanna J Ryan, Des C Winter
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引用次数: 0
Acute large bowel obstruction. 急性大肠梗阻
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae202
Gita Lingham, Michael Okocha, Ben Griffiths
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引用次数: 0
Corrigendum to: Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. 更正:减少右结肠切除术后吻合口漏的质量改进干预评估 (EAGLE):在 64 个国家进行的务实、分批阶梯式、分组随机试验。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae032
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引用次数: 0
Penetrating abdominal trauma. 腹部穿透性创伤
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae206
Ewan Kyle, Sally Grice, David N Naumann
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引用次数: 0
Effects of limb lengths in gastric bypass surgery. 胃旁路手术中肢体长度的影响。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae220
Adisa Poljo, Ralph Peterli, Marko Kraljević
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引用次数: 0
Sex-related differences in oncological surgery and postoperative outcomes: comprehensive, nationwide study in France. 肿瘤手术和术后结果的性别差异:法国全国范围内的综合研究。
IF 8.6 1区 医学 Q1 SURGERY Pub Date : 2024-08-02 DOI: 10.1093/bjs/znae179
Floriane Jochum, Anne-Sophie Hamy, Paul Gougis, Élise Dumas, Beatriz Grandal, Mathilde Sauzey, Enora Laas, Jean-Guillaume Feron, Virginie Fourchotte, Thomas Gaillard, Noemie Girard, Lea Pauly, Elodie Gauroy, Lauren Darrigues, Judicael Hotton, Lise Lecointre, Fabien Reyal, Fabrice Lecuru, Cherif Akladios

Background: The main objective of this study was to undertake an exhaustive investigation of sex-related differences in cancer surgery.

Methods: This observational study used data from the French national health insurance system database covering 98.8% of the population. Patients diagnosed with non-sex-specific solid invasive cancers between January 2018 and December 2019 were included. The main outcomes were likelihood of undergoing cancer surgery, type of oncological surgery performed, and associated 30-, 60-, and 90-day postoperative reoperation and mortality rates, by sex.

Results: For the 367 887 patients included, women were 44% more likely than men to undergo cancer surgery (OR 1.44, 95% c.i. 1.31 to 1.59; P < 0.001). However, the likelihood of surgery decreased with advancing age (OR 0.98, 0.98 to 0.98; P < 0.001), and with increasing number of co-morbid conditions (OR 0.95, 0.95 to 0.96; P < 0.001), especially in women. Men had higher 90-day reoperation (21.2 versus 18.8%; P < 0.001) and mortality (1.2 versus 0.9%; P < 0.001) rates than women, overall, and for most cancer types, with the exception of bladder cancer, for which the 90-day mortality rate was higher among women (1.8 versus 1.4%; P < 0.001). After adjustment for age, number of co-morbid conditions, and surgical procedure, 90-day mortality remained higher in men (OR 1.16, 1.07 to 1.26; P < 0.001), and men were 21% more likely than women to undergo reoperation within 90 days (OR 1.21, 1.18 to 1.23; P < 0.001).

Conclusion: Women were much more likely than men to undergo cancer surgery than men, but the likelihood of surgery decreased with advancing age and with increasing number of co-morbid conditions, especially in women. These findings highlight a need for both increased awareness and strategies to ensure gender equality in access to oncological surgical treatment and improved outcomes.

背景:本研究的主要目的是详尽调查癌症手术中与性别有关的差异:本研究的主要目的是对癌症手术中的性别差异进行详尽调查:这项观察性研究使用的数据来自法国国家医疗保险系统数据库,覆盖了98.8%的人口。研究纳入了2018年1月至2019年12月期间诊断为非性别特异性实体侵袭性癌症的患者。主要结果是接受癌症手术的可能性、所实施的肿瘤手术类型,以及相关的术后30天、60天和90天再手术率和死亡率(按性别分列):在纳入的 367 887 名患者中,女性接受癌症手术的可能性比男性高 44%(OR 1.44,95% c.i. 1.31 至 1.59;P <0.001)。然而,随着年龄的增长(OR 0.98,0.98 至 0.98;P <0.001)和并发症数量的增加(OR 0.95,0.95 至 0.96;P <0.001),手术的可能性会降低,尤其是女性。总体而言,男性的90天再次手术率(21.2%对18.8%;P<0.001)和死亡率(1.2%对0.9%;P<0.001)高于女性,大多数癌症类型也是如此,但膀胱癌除外,女性的90天死亡率更高(1.8%对1.4%;P<0.001)。在对年龄、并发症数量和手术方式进行调整后,男性的90天死亡率仍然较高(OR 1.16,1.07至1.26;P <0.001),男性在90天内再次手术的可能性比女性高21%(OR 1.21,1.18至1.23;P <0.001):女性比男性更有可能接受癌症手术,但随着年龄的增长和并发症的增加,手术的可能性会降低,尤其是女性。这些研究结果突出表明,有必要提高人们的认识并制定相关策略,以确保在接受肿瘤外科治疗和改善治疗效果方面实现性别平等。
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British Journal of Surgery
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