Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Introduction: Medullary thyroid cancer (MTC) is a potentially aggressive thyroid malignancy arising from parafollicular C-cells. While current evidence demonstrates a rising incidence of differentiated thyroid cancer (DTC) both in Ireland and globally, trends in MTC incidence and prognosis remain less well defined. This study aims to analyse the incidence, management and survival of patients with MTC in the Irish population.

Methods: A retrospective analysis of patients diagnosed with MTC between 1994 and 2019 was performed using data from the Irish National Cancer Registry (NCRI). Patients were grouped into two time periods: 1994-2007 and 2008-2019. Kaplan-Meier survival analysis was used to estimate overall survival (OS) and disease-specific survival (DSS). Univariate and multivariate Cox proportional hazard models were applied to identify factors associated with survival outcomes.

Results: A total of 152 patients were diagnosed with MTC. The median age at diagnosis was 53 years. The incidence rate was 0.14 cases per 100,000 person-years. Five-year OS and DSS were 67% and 73.2%, respectively. On multivariate analysis, surgical management was independently associated with improved OS and DSS (HR 0.18, p = 0.013), while chemotherapy was associated with significantly poorer survival (HR 4.29, p = 0.014).

Conclusion: This study highlights evolving trends in the incidence, management and survival of patients with MTC in Ireland over a 25-year period. A trend towards improved overall survival was observed in patients diagnosed in the later cohort.

Background: The association between diverticulitis and colorectal (CRC) remains controversial, with current guidelines differing significantly in terms of post-diverticulitis endoscopic assessment. This study is aimed at developing an exploratory model to identify patients at high risk of CRC following diverticulitis.

Methods: This retrospective cohort study analyzed 1546 patients diagnosed with diverticulitis between January 2021 and December 2023 at a UK tertiary care hospital. Ordinal logistic regression was used to identify predictors associated with CRC risk.

Results: Of 1546 patients, the mean age was 69.2 years SD ± 12.9, and 51.5 % were female. Increasing age (OR 1.28 per SD, 95 % CI 1.14-1.45, p < 0.001) and male sex (OR 1.75, 95 % CI 1.39-2.21, p < 0.001) were high risk predictors associated with increased risk of CRC. Conversely, abdominal pain (OR 0.60, 95 % CI 0.44-0.80, p = 0.001) and per-rectal bleeding (OR 0.71, 95 % CI 0.56-0.89, p = 0.004), and presence of diverticulosis showed a protective association (OR 0.68, 95 % CI 0.47-0.97, p = 0.033), which could be due to confounding. CT findings did not achieve statistical significance as independent predictors in the multivariable model.

Conclusions: This exploratory model identifies patient characteristics that stratify CRC risk following diverticulitis. These findings may help personalize decisions regarding post-diverticulitis colonoscopy, optimizing resource allocation while maintaining appropriate cancer surveillance. However, this model would require external validation before use in clinical practice.

Introduction: Medical students' interest in vascular surgery is influenced by varying factors, including clinical exposure, mentorship, perceived lifestyle and individual personality traits. The disruptions caused by Covid-19 affected clinical attachments, reducing exposure to different specialties and limiting opportunities for mentorship and research. More importantly, it influenced students' attitudes towards work-life balance. This study compared pre- and post-pandemic cohorts of Irish medical students to identify modifiable factors influencing vascular surgery career decisions and assess pandemic-related effects.

Methods: A cross-sectional survey was conducted at Royal College of Surgeons in Ireland (RCSI) School of Medicine during the 2017-2018 (pre-pandemic) and 2023-2024 (post-pandemic) academic years. Questionnaires were distributed via lectures, email, student societies and social media. Data collected included demographics, exposure to vascular surgery, career influences, and suggestions to increase the specialty's appeal for students. Overall trends in students' perceptions were noted and responses were compared between pre- and post-pandemic cohorts using SPSS.

Results: Of 350 respondents, 236 were pre-pandemic and 114 post-pandemic. The latter group was older, more often postgraduate entrants, in senior clinical years, and from international backgrounds. Interest in vascular surgery remained unchanged (48 % vs 44 %, p = 0.451). The main shift was that pre-pandemic students were more influenced by earning potential, mentorship, and personality traits, whereas post-pandemic students placed greater emphasis on enjoyment and work-life balance. Early clinical exposure was identified as key to enhancing understanding (p < 0.001), while flexible working hours were the top factor in making a specialty attractive (p < 0.0001). Senior students and those from North America were less likely to consider vascular surgery (p < 0.001).

Conclusions: Despite pandemic-related disruptions, interest in vascular surgery remained stable. Clinical exposure, mentorship, and work-life balance continue to be central influences. Flexible training, earlier exposure, and structured mentorship could strengthen recruitment, with emphasis on reinforcing collaboration between medical schools and surgical faculty.

Background: Neurodiversity encompasses natural variations in cognitive functioning, including autism spectrum disorder, ADHD, and specific learning difficulties. While the concept is increasingly recognised in education and general workplaces, its relevance in medicine and particularly in surgery, remains underexplored.

Methods: We conducted a systematic review in accordance with PRISMA 2020. Searches of PubMed, Embase, Medline, Global Health and PsycINFO databases up to July 2025 identified studies on neurodivergence among surgeons and healthcare professionals. Eligible publications addressed neurodiversity explicitly or reported disability data inclusive of neurodivergent surgeons. Two reviewers independently screened, extracted, and appraised studies using JBI and MMAT tools. Narrative synthesis was organised into five domains: prevalence/disclosure, challenges and attainment, cognitive strengths, workplace supports, and cultural implications.

Results: Of 13268 records, four studies met inclusion criteria: two retrospective cohorts, one cross-sectional, and one mixed-methods study from Turkey, Canada, and the UK. Prevalence estimates varied: ADHD symptoms were identified in 31.6 % of included Turkish surgical trainees who participated in the study, while 6-8 % of UK trainees declared disabilities, most commonly specific learning difficulties. Neurodivergent trainees reported challenges with assessments, sensory environments, and professional expectations, with lower pass rates in early postgraduate exams. Strengths including creativity, attention to detail, and resilience were frequently cited. Evidence suggested that supportive interventions and fair recruitment processes can mitigate disadvantage.

Conclusions: Neurodiversity in surgery is under-recognised yet integral to workforce diversity. Neurodivergent surgeons contribute valuable skills but face systemic and cultural barriers. Greater awareness, structured accommodations, and inclusive training frameworks are needed to reduce stigma, promote disclosure, and enable all surgeons to thrive.

Background: This study sets out to review our experience with the management of abdominal shotgun wounds (SGWs). The aim of this study was to review the spectrum, injury pattern, clinical outcome as well as the applicability of selective non-operative management (SNOM) to abdominal SGWs managed at our institution.

Methods: Patients presenting with abdominal gunshot wounds (GSWs) between January 2012 to December 2024, were retrospectively reviewed from the Hybrid Electronic Medical Registry (HEMR). During the same study period, direct comparison was made between abdominal GSWs and SGWs. Data included demographics, injury pattern, body region injuries, diagnostic imaging, operative interventions and clinical outcome.

Results: During the twelve-year study period, a total of 1060 patients sustained an abdominal GSW of which 41 (4 %) sustained an abdominal SGW and were included in the study. 30 abdominal SGW patients (73 %) required a laparotomy, and of these, 14 (47 %) were damage control laparotomies (DCL). There was a more liberal use of computed tomography (CT) scans in patients with SGWs (83 % versus 54 %, p < 0.001) however, there were no statistical significances in SNOM attempt rates (28 % versus 32 %, p = 0.602) and success rates (85 % versus 95 %, p = 0.161).

Conclusion: The management of abdominal SGWs is challenging and imaging is essential due to the unpredictable behaviour of the multiple pellets. Although there is a significant rate of operation with a high rate of damage control surgery, a select cohort can be managed non-operatively without increased mortality.

Background: Accurate assessment and documentation of wound sizes essential for effective communication between clinicians and appropriate management of traumatic injuries. Inaccurate estimations can lead to inappropriate referrals and delayed treatment. While numerous measurement techniques exist, body-based estimation remains the most practical in emergency settings. This study aimed to determine the accuracy of clinicians' wound size estimations before and after using reference hand measurements as a calibration tool.

Methods: A cross-sectional interventional observational study was conducted at a major trauma centre in the UK. Sixty-three clinicians of varying grades and specialties were asked to estimate the lengths of three pre-measured artificial wounds (17 cm, 7 cm and 2 cm) using any method of their choice. Participants then measured specific hand segments (thumb width, index finger length, and thumb-index span) and repeated the wound length estimations using these as reference points. Differences between actual and estimated wound lengths were recorded, and pre- and post-intervention accuracy was compared using paired-samples t-tests and Pearson's correlation coefficient. Subgroup analyses explored differences by gender, specialty, and clinical experience.

Results: All participants completed the study. Wound length estimation accuracy significantly improved after the intervention across all three wounds (p < 0.0001). The average error for the 17 cm, 7 cm and 2 cm wounds were 3.1 cm, 1.8 cm and 0.7 cm respectively which reduced to 1.0 cm, 0.6 cm and 0.2 cm following hand measurement. Therefore, the cumulative mean error decreased from 5.6 cm pre-intervention to 1.8 cm post-intervention, representing a 68 % reduction in error. No significant differences were found between male and female participants, or between surgical and medical specialties. A weak, non-significant correlation was observed between clinical experience and estimation accuracy.

Conclusion: Using simple hand-based reference measurements significantly improves clinicians' accuracy in estimating wound length. This free, rapid, and universally applicable method can enhance communication and clinical decision-making where formal measuring tools are unavailable, and its adoption is encouraged in acute care and emergency settings.