BACKGROUNDThe incidence of early-onset (EO) gastrointestinal (GI) cancers-commonly defined as being diagnosed in patients <50 years of age-is rising at an alarming rate globally. The rising incidence demonstrates a birth cohort effect, implicating environmental factors, such as diet and lifestyle; however, the drivers behind this trend are not yet known.METHODSA comprehensive narrative review of the literature was conducted, focusing on EO colorectal, oesophagogastric, and pancreatic cancers. Additionally, the literature on less common EO GI cancers, including appendiceal, biliary, and neuroendocrine tumours, was reviewed. Epidemiological trends, risk factors, clinical and molecular characteristics, germline and somatic genetic features, and outcomes across these diseases were examined.RESULTSEO GI cancers have demonstrated a consistent rise in incidence, which disproportionally affects black, Hispanic, and indigenous populations and women. Though germline pathogenic variants are more common in EO GI cancers compared with average-onset GI cancers, most cases occur sporadically. Modifiable risk factors associated with an increased risk of EO GI cancers include obesity, a Western-pattern diet, non-alcoholic fatty liver disease, smoking, and alcohol use, among others. Across GI cancers, younger patients frequently present with more aggressive disease features and receive more intensive treatment compared with older patients. Survival outcomes are inconsistent across studies.CONCLUSIONEO GI cancers represent clinically distinct disease entities that are associated with unique challenges in screening, management, and survivorship. A better understanding of underlying aetiologies, optimized screening strategies, and improved survivorship support are necessary. Meeting the needs of this growing patient population will require a multidisciplinary, equity-based approach in both clinical care and research.
{"title":"Early-onset gastrointestinal cancers: comprehensive review and future directions.","authors":"Sara K Char,Catherine A O'Connor,Kimmie Ng","doi":"10.1093/bjs/znaf102","DOIUrl":"https://doi.org/10.1093/bjs/znaf102","url":null,"abstract":"BACKGROUNDThe incidence of early-onset (EO) gastrointestinal (GI) cancers-commonly defined as being diagnosed in patients <50 years of age-is rising at an alarming rate globally. The rising incidence demonstrates a birth cohort effect, implicating environmental factors, such as diet and lifestyle; however, the drivers behind this trend are not yet known.METHODSA comprehensive narrative review of the literature was conducted, focusing on EO colorectal, oesophagogastric, and pancreatic cancers. Additionally, the literature on less common EO GI cancers, including appendiceal, biliary, and neuroendocrine tumours, was reviewed. Epidemiological trends, risk factors, clinical and molecular characteristics, germline and somatic genetic features, and outcomes across these diseases were examined.RESULTSEO GI cancers have demonstrated a consistent rise in incidence, which disproportionally affects black, Hispanic, and indigenous populations and women. Though germline pathogenic variants are more common in EO GI cancers compared with average-onset GI cancers, most cases occur sporadically. Modifiable risk factors associated with an increased risk of EO GI cancers include obesity, a Western-pattern diet, non-alcoholic fatty liver disease, smoking, and alcohol use, among others. Across GI cancers, younger patients frequently present with more aggressive disease features and receive more intensive treatment compared with older patients. Survival outcomes are inconsistent across studies.CONCLUSIONEO GI cancers represent clinically distinct disease entities that are associated with unique challenges in screening, management, and survivorship. A better understanding of underlying aetiologies, optimized screening strategies, and improved survivorship support are necessary. Meeting the needs of this growing patient population will require a multidisciplinary, equity-based approach in both clinical care and research.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"21 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578720","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}
Koichi Tomita, Masashi Takeuchi, Jessica E Maxwell, Rebecca A Snyder, Michael P Kim, Hop S Tran Cao, Ching-Wei D Tzeng, Jeffrey E Lee, Matthew H G Katz, Naruhiko Ikoma
{"title":"Automated surgical phase recognition for robotic pancreatoduodenectomy using artificial intelligence.","authors":"Koichi Tomita, Masashi Takeuchi, Jessica E Maxwell, Rebecca A Snyder, Michael P Kim, Hop S Tran Cao, Ching-Wei D Tzeng, Jeffrey E Lee, Matthew H G Katz, Naruhiko Ikoma","doi":"10.1093/bjs/znaf160","DOIUrl":"10.1093/bjs/znaf160","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 7","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726192","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}
Christin Hoffmann,Daisy Elliott,Leila Rooshenas,Cynthia Ochieng,Barry Main,Pete Wheatstone,Samuel Lawday,Abigail Vallance,Jane M Blazeby,Angus G K McNair,
BACKGROUNDThere are repeated and ongoing failures in shared decision-making and informed consent for innovative surgical procedures. Governments and regulatory bodies internationally recommend establishing information standards to support safe and transparent surgical innovation. The aim of this study was to develop a core information set (CIS) for surgical innovation.METHODSThis was a mixed-method study in three phases: a provisional CIS was generated from multiple data sources (interviews with patients/professionals (44), recorded consultations (34), policy documents (58), and published studies (213)) using qualitative content analysis; the CIS was refined, with input from key stakeholders (patient representatives, surgeon innovators, anaesthetists, lawyers, ethicists, medical directors, academic experts, and regulatory representatives) using a modified nominal group technique; and the CIS was finalized through public consultation.RESULTSThe final CIS comprised seven themes that included: what is 'new' about the procedure; potential conflicts of interest; reasons for the innovation (including why the innovation is believed to be appropriate for the patient); treatment alternatives; unknowns (including uncertain safety/efficacy and that the procedure may be abandoned/modified); expertise with the innovation; and governance, oversight, and accountability (including how safety will be monitored and recompense if anything goes wrong). Two themes require follow-up discussions after the procedure.CONCLUSIONA seven-theme CIS for surgical innovation was co-developed, with input from key stakeholders. International implementation of these information standards may support safe and transparent surgical innovation.
{"title":"Information standards for innovative surgery: what patients need to know.","authors":"Christin Hoffmann,Daisy Elliott,Leila Rooshenas,Cynthia Ochieng,Barry Main,Pete Wheatstone,Samuel Lawday,Abigail Vallance,Jane M Blazeby,Angus G K McNair, ","doi":"10.1093/bjs/znaf140","DOIUrl":"https://doi.org/10.1093/bjs/znaf140","url":null,"abstract":"BACKGROUNDThere are repeated and ongoing failures in shared decision-making and informed consent for innovative surgical procedures. Governments and regulatory bodies internationally recommend establishing information standards to support safe and transparent surgical innovation. The aim of this study was to develop a core information set (CIS) for surgical innovation.METHODSThis was a mixed-method study in three phases: a provisional CIS was generated from multiple data sources (interviews with patients/professionals (44), recorded consultations (34), policy documents (58), and published studies (213)) using qualitative content analysis; the CIS was refined, with input from key stakeholders (patient representatives, surgeon innovators, anaesthetists, lawyers, ethicists, medical directors, academic experts, and regulatory representatives) using a modified nominal group technique; and the CIS was finalized through public consultation.RESULTSThe final CIS comprised seven themes that included: what is 'new' about the procedure; potential conflicts of interest; reasons for the innovation (including why the innovation is believed to be appropriate for the patient); treatment alternatives; unknowns (including uncertain safety/efficacy and that the procedure may be abandoned/modified); expertise with the innovation; and governance, oversight, and accountability (including how safety will be monitored and recompense if anything goes wrong). Two themes require follow-up discussions after the procedure.CONCLUSIONA seven-theme CIS for surgical innovation was co-developed, with input from key stakeholders. International implementation of these information standards may support safe and transparent surgical innovation.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"12 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578719","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}
Floris F E Bruinsma, Saija Hurme, Ralph Peterli, Erik Stenberg, Simon W Nienhuijs, Sofia Grönroos, Villy Våge, Marco Bueter, Johan Ottosson, Ronald S L Liem, Paulina Salminen
Background: The Swiss-Finnish Bariatric Metabolic Outcome Score (SF-BARI Score), based on merged data of two RCTs, is a composite endpoint designed to evaluate and categorize outcomes after metabolic bariatric surgery (MBS). The aim of this study was to externally validate the score using registry data.
Methods: Individual patient data were included from the Dutch Audit for Treatment of Obesity, the Scandinavian Obesity Surgery Registries (SOReg-Sweden and SOReg-Norway), and the merged RCT data used for establishing the SF-BARI Score. All patients undergoing primary MBS from January 2010 to June 2018, with complete baseline characteristics, as well as complete 1- and 5-year follow-up data, were included. The mean total score and distribution were compared between the combined registry and merged RCT data.
Results: There was no statistically significant difference in the mean SF-BARI Score between the registries (21 603 patients) and merged RCTs (457 patients) at 5 years (90.9 versus 89.1 points; difference = 1.8 (95% c.i. -1.0 to 4.7); P = 0.212), and the score distribution was similar. Statistically significant differences in baseline characteristics existed regarding sex (male 20.9% versus 29.3%), type 2 diabetes (16.7% versus 33.9%), hypertension (30.4% versus 66.1%), dyslipidaemia (13.7% versus 46.5%), obstructive sleep apnoea syndrome (12.0% versus 17.4%), and sleeve gastrectomy (SG) rate (21.0% versus 49.9%) (P < 0.001). The mean score estimate at 5 years in Roux-en-Y gastric bypass was 11.2 (95% c.i. 10.2 to 12.2) points higher compared with SG (P < 0.001).
Conclusion: This study verified the feasibility of the SF-BARI Score, enabling standardized reporting and allowing for comparison of different treatment modalities.
{"title":"Validation of the Swiss-Finnish Bariatric Metabolic Outcome Score within a large prospective registry cohort.","authors":"Floris F E Bruinsma, Saija Hurme, Ralph Peterli, Erik Stenberg, Simon W Nienhuijs, Sofia Grönroos, Villy Våge, Marco Bueter, Johan Ottosson, Ronald S L Liem, Paulina Salminen","doi":"10.1093/bjs/znaf106","DOIUrl":"https://doi.org/10.1093/bjs/znaf106","url":null,"abstract":"<p><strong>Background: </strong>The Swiss-Finnish Bariatric Metabolic Outcome Score (SF-BARI Score), based on merged data of two RCTs, is a composite endpoint designed to evaluate and categorize outcomes after metabolic bariatric surgery (MBS). The aim of this study was to externally validate the score using registry data.</p><p><strong>Methods: </strong>Individual patient data were included from the Dutch Audit for Treatment of Obesity, the Scandinavian Obesity Surgery Registries (SOReg-Sweden and SOReg-Norway), and the merged RCT data used for establishing the SF-BARI Score. All patients undergoing primary MBS from January 2010 to June 2018, with complete baseline characteristics, as well as complete 1- and 5-year follow-up data, were included. The mean total score and distribution were compared between the combined registry and merged RCT data.</p><p><strong>Results: </strong>There was no statistically significant difference in the mean SF-BARI Score between the registries (21 603 patients) and merged RCTs (457 patients) at 5 years (90.9 versus 89.1 points; difference = 1.8 (95% c.i. -1.0 to 4.7); P = 0.212), and the score distribution was similar. Statistically significant differences in baseline characteristics existed regarding sex (male 20.9% versus 29.3%), type 2 diabetes (16.7% versus 33.9%), hypertension (30.4% versus 66.1%), dyslipidaemia (13.7% versus 46.5%), obstructive sleep apnoea syndrome (12.0% versus 17.4%), and sleeve gastrectomy (SG) rate (21.0% versus 49.9%) (P < 0.001). The mean score estimate at 5 years in Roux-en-Y gastric bypass was 11.2 (95% c.i. 10.2 to 12.2) points higher compared with SG (P < 0.001).</p><p><strong>Conclusion: </strong>This study verified the feasibility of the SF-BARI Score, enabling standardized reporting and allowing for comparison of different treatment modalities.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 6","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191302","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}
BACKGROUNDRemoval of Kirschner wires (K-wires) after fracture treatment in the upper limb is unpleasant for children. The aim of this study was to evaluate whether virtual reality (VR) distraction could improve pain and the overall experience for children.METHODSAn RCT was performed in a single outpatient fracture clinic, where children (aged 6-15 years) were randomized 1 : 1, in three age strata, to additional VR or standard of care. Pain perception was assessed using the Wong-Baker Faces Pain Rating Scale by neutral observers and later by the patients and their guardians. Further measures included the Face/Legs/Activity/Cry/Consolability (FLACC) Pain Scale, the modified Yale Pain Anxiety Scale (mYPAS), and questionnaires, as well as objective data, such as heart rate variability and blood pressure.RESULTSA total of 146 patients were recruited into the trial. The VR group showed significantly less pain on the Wong-Baker Faces Pain Rating Scale (OR 0.23 (95% c.i. 0.12 to 0.43)) compared with the control group. Observers rated the pain >2 for 43% of patients in the VR group and 74% of patients in the control group. Observer scales (the FLACC Pain Scale and the mYPAS) during K-wire removal also indicated less pain (OR 0.36 (95% c.i. 0.19 to 0.24) and 0.29 (95% c.i. 0.16 to 0.52) respectively). The difference in pain rated >2 between the VR and control group was smaller directly after (59% versus 69% respectively) and 2 weeks after (58% versus 70% respectively) K-wire removal. Children in the VR group were less aware of the painful stimulus directly after and 2 weeks after wire extraction.CONCLUSIONVR distraction effectively reduces pain during K-wire removal in children. VR positively impacts the procedural memory of children.REGISTRATION NUMBERDRKS00020229 (Deutsches Register Klinischer Studien (DRKS; that is the German Clinical Trials Register); date of registration 10 December 2019).
背景：儿童在上肢骨折治疗后取出克氏针是不愉快的。这项研究的目的是评估虚拟现实（VR）分心是否能改善儿童的疼痛和整体体验。方法在一个骨折门诊进行一项随机对照试验，其中6-15岁的儿童（6-15岁）在三个年龄层中以1:1的比例随机分配到额外的VR或标准护理。疼痛知觉由中立观察者和患者及其监护人分别使用Wong-Baker面部疼痛评定量表进行评估。进一步的测量包括面部/腿部/活动/哭泣/安慰（FLACC）疼痛量表，改进的耶鲁疼痛焦虑量表（mYPAS），问卷调查以及客观数据，如心率变异性和血压。结果共纳入146例患者。与对照组相比，VR组在Wong-Baker面部疼痛评定量表上的疼痛明显减轻（OR 0.23 (95% ci . 0.12至0.43)）。观察人员对VR组中43%的患者和对照组中74%的患者的疼痛评分为>2。观察量表（FLACC疼痛量表和mYPAS）在取丝过程中也显示疼痛减轻（OR分别为0.36 （95% ci . 0.19至0.24）和0.29 (95% ci . 0.16至0.52)）。VR组和对照组在取下k线后（分别为59%和69%）和2周后（分别为58%和70%）疼痛评分>2的差异较小。VR组患儿在拔线后和拔线后2周对疼痛刺激的意识较弱。结论vr牵引可有效减轻儿童k线拔除术中的疼痛。虚拟现实正向影响儿童的程序记忆。注册号drks00020229(德国注册克里尼斯彻学生(DRKS；即德国临床试验注册)；注册日期2019年12月10日)。
{"title":"Effect of virtual reality on pain and stress in children during Kirschner-wire removal after fracture treatment: a randomized clinical trial.","authors":"Kathrin Kelly,Juliane Pretzsch,Lena Altenburger,Julia Siebert,Alexander Tzabazis,Judith Lindert,Reinhard Vonthein,Ludger Tüshaus","doi":"10.1093/bjs/znaf075","DOIUrl":"https://doi.org/10.1093/bjs/znaf075","url":null,"abstract":"BACKGROUNDRemoval of Kirschner wires (K-wires) after fracture treatment in the upper limb is unpleasant for children. The aim of this study was to evaluate whether virtual reality (VR) distraction could improve pain and the overall experience for children.METHODSAn RCT was performed in a single outpatient fracture clinic, where children (aged 6-15 years) were randomized 1 : 1, in three age strata, to additional VR or standard of care. Pain perception was assessed using the Wong-Baker Faces Pain Rating Scale by neutral observers and later by the patients and their guardians. Further measures included the Face/Legs/Activity/Cry/Consolability (FLACC) Pain Scale, the modified Yale Pain Anxiety Scale (mYPAS), and questionnaires, as well as objective data, such as heart rate variability and blood pressure.RESULTSA total of 146 patients were recruited into the trial. The VR group showed significantly less pain on the Wong-Baker Faces Pain Rating Scale (OR 0.23 (95% c.i. 0.12 to 0.43)) compared with the control group. Observers rated the pain >2 for 43% of patients in the VR group and 74% of patients in the control group. Observer scales (the FLACC Pain Scale and the mYPAS) during K-wire removal also indicated less pain (OR 0.36 (95% c.i. 0.19 to 0.24) and 0.29 (95% c.i. 0.16 to 0.52) respectively). The difference in pain rated >2 between the VR and control group was smaller directly after (59% versus 69% respectively) and 2 weeks after (58% versus 70% respectively) K-wire removal. Children in the VR group were less aware of the painful stimulus directly after and 2 weeks after wire extraction.CONCLUSIONVR distraction effectively reduces pain during K-wire removal in children. VR positively impacts the procedural memory of children.REGISTRATION NUMBERDRKS00020229 (Deutsches Register Klinischer Studien (DRKS; that is the German Clinical Trials Register); date of registration 10 December 2019).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"30 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311324","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}
Charles T West,Abhinav Tiwari,Julian Smith,Hideaki Yano,Malcolm A West,Alex H Mirnezami,
BACKGROUNDPelvic exenteration (PE) is a potentially curative treatment for advanced pelvic cancers. However, PE procedures are associated with empty pelvis syndrome (EPS), a spectrum of complications including pelvic sepsis, sinus formation, fistulae, and bowel obstruction. Inconsistent reporting has impeded progress in understanding EPS. The PelvEx Collaborative introduced a core data set of descriptors and outcomes to address these issues and the aim of this study was to validate this data set.METHODSAn observational cohort study applied the EPS core data set to a prospectively maintained PE database. Patterns of major and minor manifestations were evaluated; logistic regression was used to explore relationships between descriptors and outcomes, and inter-descriptor correlation was assessed using Cramer's V.RESULTSEPS occurred in 32.1% of patients (105 of 327) and was the leading cause of major morbidity. Infected pelvic collections (occurring in 23.5%) were associated with subsequent chronic sinus formation (OR 3.08, P = 0.01) and fistulae (P = 0.05). The risk of EPS increased with external beam radiotherapy (OR 1.01 per 1 Gy, P = 0.01), sacrectomy (OR 3.78, P < 0.001), total cystectomy (OR 2.46, P = 0.001), internal iliac vessel ligation (unilateral OR 1.94, P = 0.045; bilateral OR 3.65, P < 0.001), and infralevator exenteration (OR 3.69, P < 0.001). Omentoplasty reduced pelvic bowel obstruction (OR 0.27, P = 0.004) and perineal flaps were linked to a higher rate of reconstruction-related major morbidity compared with biological mesh alone (20.8% versus 1.2% respectively, P = 0.002).CONCLUSIONThe PelvEx Collaborative core data set standardizes reporting of EPS, with this study detailing the acute and chronic complications arising as a consequence. Biological mesh was associated with reduced reconstruction-related morbidity compared with perineal flaps. Further validation in additional cohorts is required to address potential confounding factors.
盆腔切除术（PE）是一种治疗晚期盆腔癌的潜在治疗方法。然而，PE手术与骨盆空综合征（EPS）相关，包括骨盆败血症、窦形成、瘘管和肠梗阻等一系列并发症。不一致的报告阻碍了对每股收益的理解。PelvEx协作引入了一个描述符和结果的核心数据集来解决这些问题，本研究的目的是验证该数据集。方法一项观察性队列研究将EPS核心数据集应用于前瞻性维护的PE数据库。评估主要和次要表现的模式；使用逻辑回归来探索描述符与结果之间的关系，并使用Cramer's v评估描述符间的相关性。结果327例患者中有105例发生了tsps，是主要发病的主要原因。感染盆腔积液（23.5%）与随后的慢性窦形成（OR 3.08, P = 0.01）和瘘管（P = 0.05）相关。外束放疗（OR 1.01 / 1gy, P = 0.01）、骶骨切除术（OR 3.78, P < 0.001）、全膀胱切除术（OR 2.46, P = 0.001）、髂内血管结扎(OR 1.94, P = 0.045；双侧OR 3.65, P < 0.001)和提下肌拔出（OR 3.69, P < 0.001）。网膜成形术减少盆腔肠梗阻（OR 0.27, P = 0.004）和会阴皮瓣与单独使用生物补片相比，与重建相关的主要发病率更高（20.8%对1.2%,P = 0.002）。结论：PelvEx协作核心数据集标准化了EPS的报告，该研究详细说明了由此引起的急性和慢性并发症。与会阴皮瓣相比，生物补片可降低重建相关的发病率。需要在其他队列中进一步验证以解决潜在的混杂因素。
{"title":"Empty pelvis syndrome as a cause of major morbidity after pelvic exenteration: validation of a core data set.","authors":"Charles T West,Abhinav Tiwari,Julian Smith,Hideaki Yano,Malcolm A West,Alex H Mirnezami,","doi":"10.1093/bjs/znaf070","DOIUrl":"https://doi.org/10.1093/bjs/znaf070","url":null,"abstract":"BACKGROUNDPelvic exenteration (PE) is a potentially curative treatment for advanced pelvic cancers. However, PE procedures are associated with empty pelvis syndrome (EPS), a spectrum of complications including pelvic sepsis, sinus formation, fistulae, and bowel obstruction. Inconsistent reporting has impeded progress in understanding EPS. The PelvEx Collaborative introduced a core data set of descriptors and outcomes to address these issues and the aim of this study was to validate this data set.METHODSAn observational cohort study applied the EPS core data set to a prospectively maintained PE database. Patterns of major and minor manifestations were evaluated; logistic regression was used to explore relationships between descriptors and outcomes, and inter-descriptor correlation was assessed using Cramer's V.RESULTSEPS occurred in 32.1% of patients (105 of 327) and was the leading cause of major morbidity. Infected pelvic collections (occurring in 23.5%) were associated with subsequent chronic sinus formation (OR 3.08, P = 0.01) and fistulae (P = 0.05). The risk of EPS increased with external beam radiotherapy (OR 1.01 per 1 Gy, P = 0.01), sacrectomy (OR 3.78, P < 0.001), total cystectomy (OR 2.46, P = 0.001), internal iliac vessel ligation (unilateral OR 1.94, P = 0.045; bilateral OR 3.65, P < 0.001), and infralevator exenteration (OR 3.69, P < 0.001). Omentoplasty reduced pelvic bowel obstruction (OR 0.27, P = 0.004) and perineal flaps were linked to a higher rate of reconstruction-related major morbidity compared with biological mesh alone (20.8% versus 1.2% respectively, P = 0.002).CONCLUSIONThe PelvEx Collaborative core data set standardizes reporting of EPS, with this study detailing the acute and chronic complications arising as a consequence. Biological mesh was associated with reduced reconstruction-related morbidity compared with perineal flaps. Further validation in additional cohorts is required to address potential confounding factors.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"12 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897321","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":"Obesity is more than a number: a framework for treatment.","authors":"Ricardo V Cohen,Gerhard Prager,Paulina Salminen","doi":"10.1093/bjs/znaf100","DOIUrl":"https://doi.org/10.1093/bjs/znaf100","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"30 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903044","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}
Veerle M Wintraecken,Lori M van Roozendaal,Janine M Simons,Jolanda de Vries,Sander M J van Kuijk,Marissa L G Vane,Thijs van Dalen,Helena Sackey,Jos A van der Hage,Luc J A Strobbe,Sabine C Linn,Marc B I Lobbes,Philip M P Poortmans,Vivianne C G Tjan-Heijnen,Koen K B T van de Vijver,Helen H Westenberg,Carmen D Dirksen,Johan H W de Wilt,Liesbeth J Boersma,Marjolein L Smidt
BACKGROUNDThe non-inferiority randomized controlled trial BOOG 2013-08 investigates the oncological safety and impact on health-related quality of life (HRQoL) of sentinel lymph node biopsy (SNLB) omission in cT1-2 N0 breast cancer. The primary aim of the present study was to compare patient-reported arm function and HRQoL up to 3 years after study inclusion in cT1-2 N0 patients with breast cancer undergoing breast-conserving surgery (BCS) with or without SLNB. The secondary aim was to explore the association between personality traits 'trait anxiety' and 'neuroticism', and perceived arm function and HRQoL.METHODSA total of 1733 women with unilateral cT1-2 N0 invasive breast cancer treated with BCS with or without SLNB were included. The primary outcomes of arm function (assessed using the Lymphoedema Functioning, Disability, and Health Questionnaire) and HRQoL (assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR-23 questionnaires) were analysed.RESULTSAnalyses included 821 patients (383 with SLNB and 438 without SLNB). Those in the SLNB group experienced a slight, temporary decline in arm function (P < 0.025) and reported more HRQoL arm and breast symptoms (P < 0.049). High trait anxiety or neuroticism was associated with significant poorer arm function and lower HRQoL.CONCLUSIONSLNB slightly reduced arm function, temporarily affecting HRQoL arm and breast symptoms. Neuroticism significantly negatively impacted arm function and HRQoL. Measuring and stratifying for personality traits is crucial for interpreting patient-reported outcomes and to identify patients needing additional support after surgery.REGISTRATION NUMBERNCT02271828 (http://www.clinicaltrials.gov).
{"title":"Three-year patient-reported outcomes of the BOOG 2013-08 RCT evaluating omission of sentinel lymph node biopsy in early-stage breast cancer patients treated with breast conserving surgery: Impact of personality traits on health-related quality of life.","authors":"Veerle M Wintraecken,Lori M van Roozendaal,Janine M Simons,Jolanda de Vries,Sander M J van Kuijk,Marissa L G Vane,Thijs van Dalen,Helena Sackey,Jos A van der Hage,Luc J A Strobbe,Sabine C Linn,Marc B I Lobbes,Philip M P Poortmans,Vivianne C G Tjan-Heijnen,Koen K B T van de Vijver,Helen H Westenberg,Carmen D Dirksen,Johan H W de Wilt,Liesbeth J Boersma,Marjolein L Smidt","doi":"10.1093/bjs/znaf031","DOIUrl":"https://doi.org/10.1093/bjs/znaf031","url":null,"abstract":"BACKGROUNDThe non-inferiority randomized controlled trial BOOG 2013-08 investigates the oncological safety and impact on health-related quality of life (HRQoL) of sentinel lymph node biopsy (SNLB) omission in cT1-2 N0 breast cancer. The primary aim of the present study was to compare patient-reported arm function and HRQoL up to 3 years after study inclusion in cT1-2 N0 patients with breast cancer undergoing breast-conserving surgery (BCS) with or without SLNB. The secondary aim was to explore the association between personality traits 'trait anxiety' and 'neuroticism', and perceived arm function and HRQoL.METHODSA total of 1733 women with unilateral cT1-2 N0 invasive breast cancer treated with BCS with or without SLNB were included. The primary outcomes of arm function (assessed using the Lymphoedema Functioning, Disability, and Health Questionnaire) and HRQoL (assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR-23 questionnaires) were analysed.RESULTSAnalyses included 821 patients (383 with SLNB and 438 without SLNB). Those in the SLNB group experienced a slight, temporary decline in arm function (P < 0.025) and reported more HRQoL arm and breast symptoms (P < 0.049). High trait anxiety or neuroticism was associated with significant poorer arm function and lower HRQoL.CONCLUSIONSLNB slightly reduced arm function, temporarily affecting HRQoL arm and breast symptoms. Neuroticism significantly negatively impacted arm function and HRQoL. Measuring and stratifying for personality traits is crucial for interpreting patient-reported outcomes and to identify patients needing additional support after surgery.REGISTRATION NUMBERNCT02271828 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"8 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945411","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":"Correction to: Endovascular treatment of peripheral arterial disease: Endo-STAR framework for the design, conduct, and reporting of trials.","authors":"","doi":"10.1093/bjs/znaf105","DOIUrl":"https://doi.org/10.1093/bjs/znaf105","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"27 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915184","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}
Russell S Martins,Warda Ahmed,M Umar Mahar,Ayilkin Çelik,Jeffrey Luo,Syed S Razi,Kostantinos Poulikidis,M Jawad Latif,Kyle Tafuri,Mahim A Malik,Faiz Y Bhora,
{"title":"Beyond the operating room: surgeons' perceptions of the environmental footprint of the healthcare sector.","authors":"Russell S Martins,Warda Ahmed,M Umar Mahar,Ayilkin Çelik,Jeffrey Luo,Syed S Razi,Kostantinos Poulikidis,M Jawad Latif,Kyle Tafuri,Mahim A Malik,Faiz Y Bhora,","doi":"10.1093/bjs/znaf088","DOIUrl":"https://doi.org/10.1093/bjs/znaf088","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"53 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915185","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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