Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献_第9页

Do social media use and patient satisfaction scores correlate with online award recognition among hip and knee arthroplasty specialists? 社交媒体的使用和患者满意度评分与髋关节和膝关节置换术专家获得的在线奖项认可是否相关？

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-26 DOI: 10.1016/j.surge.2024.04.006

Andrew R. Grant , Ruijia Niu , Abigail Smith , Elisabeth R. Grant , Eric L. Smith

Introduction

The physician–patient interaction now begins before patients arrive in the office. Online ratings, social media profiles, and online award status are all components of physician online reputation which contributes to the patient's initial impressions. Therefore, it is important to understand the interplay of these factors and determine if there is a consistent trend indicating the value of this information.

Methods

We Identified all (N = 160) registered American Association of Hip and Knee Surgeons (AAHKS) in New England using the https://findadoctor.aahks.net/tool for Massachusetts (MA), Connecticut (CT), Rhode Island (RI), Vermont (VT), New Hampshire (NH), and Maine (ME) on 6/26/2023. We collected surgeon age, fellowship graduation year, and practice type (i.e. Academic or Private). The average 5-star rating and number of ratings were collected from four websites. Any professional-use Facebook, Instagram, Twitter, LinkedIn, YouTube Channel, Personal Websites, or Institutional Websites were identified and a modified SMI Score was calculated. Finally, Castle Connolly Top Doctor, Local Magazine (e.g. Boston Magazine) Top Doctor, or the presence of having any award was noted for each surgeon.

Results

We identified several significant trends indicating that online awards were associated with higher online ratings. Social media presence, as determined by SMI Score, was also correlated with higher ratings overall and a higher likelihood of having an online award.

Conclusion

Given the observed trends and reported importance patients place on ratings and awards, surgeons may consider increasing online engagement via social media and encouraging patients to share their experience via online ratings.

介绍：现在，医生与患者之间的互动始于患者到达诊室之前。在线评分、社交媒体资料和在线获奖情况都是医生在线声誉的组成部分，这些都有助于加深患者的初步印象。因此，了解这些因素的相互作用并确定是否有一致的趋势表明这些信息的价值非常重要：我们使用 https://findadoctor.aahks.net/tool 对马萨诸塞州（MA）、康涅狄格州（CT）、罗得岛州（RI）、佛蒙特州（VT）、新罕布什尔州（NH）和缅因州（ME）在 2023 年 6 月 26 日注册的所有（N = 160）美国髋关节和膝关节外科医生协会（AAHKS）进行了识别。我们收集了外科医生的年龄、研究员毕业年份和执业类型（即学术型或私立型）。我们从四个网站收集了平均五星评级和评级次数。对任何专业使用的 Facebook、Instagram、Twitter、LinkedIn、YouTube 频道、个人网站或机构网站进行识别，并计算出修改后的 SMI 分数。最后，对每位外科医生是否获得 Castle Connolly 顶级医生、当地杂志（如《波士顿杂志》）顶级医生或任何奖项进行了记录：结果：我们发现了几个重要趋势，表明在线奖项与较高的在线评分相关。根据 SMI 分数确定的社交媒体存在也与较高的总体评分和获得在线奖项的可能性相关：鉴于观察到的趋势以及患者对评分和奖项的重视程度，外科医生可以考虑通过社交媒体提高在线参与度，并鼓励患者通过在线评分分享他们的经历。

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引用次数: 0

Association between psoas major muscle mass and CPET performance and long-term survival following major colorectal surgery: A retrospective cohort study 大肠手术后腰大肌质量与 CPET 表现和长期生存之间的关系：一项回顾性队列研究。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-22 DOI: 10.1016/j.surge.2024.04.005

Shahab Hajibandeh , Iain Gilham , Winnie Tam , Emma Kirby , Adetona Obaloluwa Babs-Osibodu , William Jones , George A. Rose , Damian M. Bailey , Christopher Morris , Rachel Hargest , Amy Clayton , Richard G. Davies

Objectives

To evaluate whether computed tomography (CT)-derived psoas major muscle measurements could predict preoperative cardiopulmonary exercise testing (CPET) performance and long-term mortality in patients undergoing major colorectal surgery and to compare predictive performance of psoas muscle measurements using 2D approach and 3D approach.

Methods

A retrospective cohort study compliant with STROCSS standards was conducted. Consecutive patients undergoing major colorectal surgery between January 2011 and January 2017 following CPET as part of their preoperative assessment were included. Regression analyses were modelled to investigate association between the CT-derived psoas major muscle mass variables [total psoas muscle area (TPMA), total psoas muscle volume (TPMV) and psoas muscle index (PMI)] and CPET performance and mortality (1-year and 5-year). Discriminative performances of the variables were evaluated using Receiver Operating Characteristic (ROC) curve analysis.

Results

A total of 457 eligible patients were included. The median TPMA and TPMV were 21 cm² (IQR: 15–27) and 274 cm³ (IQR: 201–362), respectively. The median PMI measured via 2D and 3D approaches were 7 cm²/m² (IQR: 6–9) and 99 cm³/m² (IQR: 76–120), respectively. The risks of 1-year and 5-year mortality were 7.4% and 27.1%, respectively. Regression analyses showed TPMA, TPMV, and PMI can predict preoperative CPET performance and long-term mortality. However, ROC curve analyses showed no significant difference in predictive performance amongst TPMA, TPMV, and PMI.

Conclusion

Radiologically-measured psoas muscle mass variables may predict preoperative CPET performance and may be helpful with informing more objective selection of patients for preoperative CPET and prehabilitation.

目的评估计算机断层扫描（CT）得出的腰大肌测量值是否能预测接受大肠直肠手术患者的术前心肺运动测试（CPET）表现和长期死亡率，并比较二维方法和三维方法腰大肌测量值的预测效果。方法开展了一项符合 STROCSS 标准的回顾性队列研究。研究纳入了 2011 年 1 月至 2017 年 1 月间接受大肠手术的连续患者，这些患者在术前评估中进行了 CPET。建立回归分析模型，研究 CT 导出的腰大肌质量变量（腰肌总面积 (TPMA)、腰肌总体积 (TPMV) 和腰肌指数 (PMI)）与 CPET 性能和死亡率（1 年和 5 年）之间的关联。结果共纳入了 457 名符合条件的患者。TPMA和TPMV的中位数分别为21平方厘米（IQR：15-27）和274立方厘米（IQR：201-362）。通过二维和三维方法测量的 PMI 中位值分别为 7 cm2/m2（IQR：6-9）和 99 cm3/m2（IQR：76-120）。1年和5年死亡风险分别为7.4%和27.1%。回归分析表明，TPMA、TPMV 和 PMI 可以预测术前 CPET 表现和长期死亡率。结论放射学测量的腰肌质量变量可预测术前 CPET 的表现，并有助于更客观地选择患者进行术前 CPET 和康复训练。

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引用次数: 0

‘Barbie Tox’ – A cosmetic trend with potential functional implications 芭比毒物"--一种具有潜在功能影响的美容趋势。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-17 DOI: 10.1016/j.surge.2024.04.001

Eimear M. Phoenix, Jake M. McDonnell, Joseph S. Butler, Colm Fuller, Colin M. Morrison, Roisin T. Dolan

引用次数: 0

The public's perspective on the amount of time surgeons spend operating 公众对外科医生手术时间的看法。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-16 DOI: 10.1016/j.surge.2024.03.005

Kathryn Fu, James Walmsley, Mohamed Abdelrahman, David S.Y. Chan

Background

As waiting lists for elective surgery grow, there seems to be a disconnect between the public's expectations on the amount of time surgeons spend operating compared with reality. On average, a surgeon in the NHS spends one day a week performing elective surgery. We aimed to investigate the public's perception on the amount of time surgeons spend performing elective surgery and what they would desire.

Methods

Members of the public in the UK were approached randomly either on-line or in-person to complete an anonymised 6-question survey. The questionnaire included demographic details, surgical history, occupational experience in the healthcare sector, the number of days a week they believe and wish for surgeons to be performing elective surgery.

Results

252 members of the public responded to the survey (150 females, 102 males). 38.5% have experience working in the healthcare sector and 58.5% have had surgery in the past. 83.7% believe surgeons spend at least 3 days a week performing elective surgery [3–4 days (43.2%), 5–7 days (40.5%)]. 45.7% of respondents want their surgeon to operate between 5 and 7 days per week.

Conclusion

The public appears to overestimate the amount of time that surgeons spend performing elective surgery and have unrealistic expectations of how much they want their surgeons to operate.

背景随着择期手术候诊名单的增加，公众对外科医生手术时间的期望似乎与现实脱节。在英国国家医疗服务体系中，外科医生平均每周花一天时间进行择期手术。我们的目的是调查公众对外科医生进行择期手术所花费时间的看法以及他们的期望。方法：我们通过在线或面对面的方式随机接触英国公众，让他们填写一份匿名的 6 个问题的调查问卷。问卷内容包括人口统计学细节、手术史、在医疗保健行业的职业经历、他们认为外科医生每周进行择期手术的天数以及他们希望外科医生每周进行择期手术的天数。38.5%的人有在医疗行业工作的经验，58.5%的人过去曾做过手术。83.7%的受访者认为外科医生每周至少花 3 天时间进行择期手术[3-4 天（43.2%），5-7 天（40.5%）]。45.7%的受访者希望他们的外科医生每周进行 5-7 天手术。

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引用次数: 0

Risk stratification of best medical therapy for acute uncomplicated type B intramural hematoma 急性无并发症 B 型硬膜外血肿最佳药物治疗的风险分层。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-16 DOI: 10.1016/j.surge.2024.04.004

Kelvin Jeason Yang , Huey-Shiuan Kuo , Nai-Hsin Chi , Hsi-Yu Yu , Shoei-Shen Wang , I-Hui Wu

Objectives

Best medical therapy (BMT) for acute uncomplicated type B intramural hematoma (TBIMH) is the current treatment guideline, but there is considerable controversy about subsequent clinical course and outcome, which may be associated with a significant failure rate. The purpose of this study was to identify potential risk factors for BMT failure and to develop a risk score to guide clinical decision making.

Methods

Patients with acute uncomplicated TBIMH between 2011 January and 2020 December were retrospectively studied. Logistic regression was applied to univariately assess potential risk predictors, and multivariable model results were then used to formulate a simplified predictive model for BMT failure.

Results

In a total of 61 patients, the overall rate of BMT failure was 57.4% (35/61), of which 48.6% (17/35) occurred within 28 days of onset. Logistic regression identified maximum descending aortic diameter (HR = 1.99 CI = 1.16–3.40, p = 0.012), initial IMH thickness (HR = 3.29, CI = 1.28–8.46, p = 0.013) and presence of focal contrast enhancement (HR = 3.12, CI = 1.49–6.54, p = 0.003) as potential risk predictors of BMT failure. A risk score was calculated as follows: [Max DTA diameter (mm)∗0.6876 + Max IMH thickness (mm)∗1.1918 + PAU/ULP ∗1.1369]. Freedom from BMT failure at 1 year was 72% in patients with a risk score < 4.12, compared with only 35.1% in those with a risk score ≧ 4.12.

Conclusions

In a substantial proportion of patients with acute uncomplicated TBIMH, initial BMT failed. Based on the three initial computed tomographic imaging variables, this risk score could help stratify patients at high or low risk for BMT failure and provided additional information for early intervention.

目的急性无并发症 B 型硬膜外血肿（TBIMH）的最佳药物治疗（BMT）是目前的治疗指南，但对后续临床过程和结果存在相当大的争议，这可能与显著的失败率有关。本研究旨在确定 BMT 失败的潜在风险因素，并制定一个风险评分来指导临床决策。方法回顾性研究了 2011 年 1 月至 2020 年 12 月期间急性无并发症 TBIMH 患者。结果在61名患者中，BMT失败的总比率为57.4%（35/61），其中48.6%（17/35）发生在发病28天内。逻辑回归确定降主动脉最大直径（HR = 1.99 CI = 1.16-3.40，P = 0.012）、初始 IMH 厚度（HR = 3.29，CI = 1.28-8.46，P = 0.013）和局灶造影剂增强（HR = 3.12，CI = 1.49-6.54，P = 0.003）为 BMT 失败的潜在风险预测因素。风险评分计算如下[最大 DTA 直径（毫米）∗0.6876 + 最大 IMH 厚度（毫米）∗1.1918 + PAU/ULP ∗1.1369]。风险评分< 4.12的患者1年内免于BMT失败的比例为72%，而风险评分≧ 4.12的患者仅为35.1%。基于三个初始计算机断层扫描成像变量，该风险评分可帮助对 BMT 失败的高风险或低风险患者进行分层，并为早期干预提供额外信息。

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引用次数: 0

Phallus preservation and reconstruction: 5-year outcomes of national penile cancer centralisation in the Republic of Ireland 阴茎保留和重建：爱尔兰共和国全国阴茎癌集中治疗的 5 年结果。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-13 DOI: 10.1016/j.surge.2024.04.002

Introduction

Penile cancer is a rare urological malignancy with an age-standardised incidence of 0.8 per 100,000 person-years [1]. Given this low incidence it has been suggested that centralised care may improve patient outcomes in relation to phallus sparing surgery and nodal assessment [2]. We aim to assess the outcomes after 5-years of national centralisation of penile cancer care.

Methods

A retrospective analysis of prospectively collected data was performed. All patients undergoing penile cancer surgery from January 2018 to December 2022 following centralisation of care were included. The primary outcome was proportion of phallus sparing procedures performed. Secondary outcomes were patient characteristics, histologic outcomes and procedures performed.

Results

124 patients underwent surgery in the study period. Mean age was 64.49 (±13.87). Overall, 82.3% of patients underwent phallus sparing surgery. This remained stable over the 5-year period from 2018 to 2022 at 92%, 85%, 76%, 79% and 78% respectively (p = 0.534). 62.7% had reconstruction performed, including split-thickness skin graft neoglans formation, (57.8% [n = 37]), preputial flap (32.8% [n = 21]), glans resurfacing (4.7% [n = 3]), shaft advancement flap (1.6% [n = 1]), penile shaft skin graft (1.6% [n = 1]), and partial penectomy with urethral centralisation (1.6% [n = 1]). Phallus preservation was not affected by positive nodal status (OR 0.75 [95% CI 0.249–2.266], p = 0.564) or T-stage ≥1b (OR 0.51 [95% CI 0.153–1.711], p = 0.276). There has been a significant reduction in Nx nodal status from 64% in 2017 to 15% in 2021 (p = 0.009).

Conclusion

Centralisation of treatment for rare malignancies such as penile cancer may improve oncologic outcomes and rates of phallus preservation. This study has shown centralisation to has a high rate of phallus preservation. Further long-term analysis of outcomes in Ireland is required.

引言阴茎癌是一种罕见的泌尿系统恶性肿瘤，年龄标准化发病率为每 10 万人年 0.8 例[1]。鉴于发病率较低，有人认为集中治疗可改善患者在阴茎切除手术和结节评估方面的预后[2]。我们旨在评估全国阴茎癌集中治疗 5 年后的疗效。方法对前瞻性收集的数据进行回顾性分析，纳入了 2018 年 1 月至 2022 年 12 月集中护理后接受阴茎癌手术的所有患者。主要结果是所实施的阴茎切除手术的比例。次要结果为患者特征、组织学结果和所实施的手术。平均年龄为 64.49 (±13.87)岁。总体而言，82.3%的患者接受了保留阴茎手术。从2018年到2022年的5年间，这一比例保持稳定，分别为92%、85%、76%、79%和78%（p = 0.534）。62.7%的患者进行了重建手术，包括分层厚皮移植新阴茎形成术（57.8% [n = 37]）、阴茎前皮瓣（32.8% [n = 21]）、龟头重塑术（4.7% [n = 3]）、阴茎轴前移皮瓣（1.6% [n = 1]）、阴茎轴植皮术（1.6% [n = 1]）和阴茎部分切除并尿道集中术（1.6% [n = 1]）。阴茎保留不受结节阳性状态（OR 0.75 [95% CI 0.249-2.266]，p = 0.564）或 T 分期≥1b（OR 0.51 [95% CI 0.153-1.711]，p = 0.276）的影响。Nx结节状态从2017年的64%大幅降至2021年的15%（p = 0.009）。结论集中治疗阴茎癌等罕见恶性肿瘤可改善肿瘤治疗效果和阴茎保留率。这项研究表明，集中化治疗具有较高的阴茎保留率。需要对爱尔兰的治疗效果进行进一步的长期分析。

{"title":"Phallus preservation and reconstruction: 5-year outcomes of national penile cancer centralisation in the Republic of Ireland","authors":"","doi":"10.1016/j.surge.2024.04.002","DOIUrl":"10.1016/j.surge.2024.04.002","url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>Penile cancer is a rare urological </span>malignancy with an age-standardised incidence of 0.8 per 100,000 person-years [1]. Given this low incidence it has been suggested that centralised care may improve patient outcomes in relation to </span>phallus sparing surgery and nodal assessment [2]. We aim to assess the outcomes after 5-years of national centralisation of penile cancer care.</p></div><div><h3>Methods</h3><p>A retrospective analysis of prospectively collected data was performed. All patients undergoing penile cancer surgery from January 2018 to December 2022 following centralisation of care were included. The primary outcome was proportion of phallus sparing procedures performed. Secondary outcomes were patient characteristics, histologic outcomes and procedures performed.</p></div><div><h3>Results</h3><p><span>124 patients underwent surgery in the study period. Mean age was 64.49 (±13.87). Overall, 82.3% of patients underwent phallus sparing surgery. This remained stable over the 5-year period from 2018 to 2022 at 92%, 85%, 76%, 79% and 78% respectively (p = 0.534). 62.7% had reconstruction performed, including split-thickness skin graft neoglans formation, (57.8% [n = 37]), preputial flap (32.8% [n = 21]), glans resurfacing (4.7% [n = 3]), shaft advancement flap (1.6% [n = 1]), penile shaft skin graft (1.6% [n = 1]), and partial </span>penectomy with urethral centralisation (1.6% [n = 1]). Phallus preservation was not affected by positive nodal status (OR 0.75 [95% CI 0.249–2.266], p = 0.564) or T-stage ≥1b (OR 0.51 [95% CI 0.153–1.711], p = 0.276). There has been a significant reduction in Nx nodal status from 64% in 2017 to 15% in 2021 (p = 0.009).</p></div><div><h3>Conclusion</h3><p>Centralisation of treatment for rare malignancies such as penile cancer may improve oncologic outcomes and rates of phallus preservation. This study has shown centralisation to has a high rate of phallus preservation. Further long-term analysis of outcomes in Ireland is required.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Pages 292-295"},"PeriodicalIF":2.3,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Comparative surgical outcomes of navigated vs non-navigated posterior spinal fusions in ankylosing spondylitis patients 强直性脊柱炎患者后路脊柱融合术中导航与非导航手术效果的比较。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-06 DOI: 10.1016/j.surge.2024.03.002

Harry Marland , Jake M. McDonnell , Lauren Hughes , Cronan Morrison , Kielan V. Wilson , Gráinne Cunniffe , Seamus Morris , Stacey Darwish , Joseph S. Butler

Introduction

Ankylosing Spondylitis (AS) patients with acute spinal fractures represent a challenge for practicing spine surgeons due to difficult operative anatomy and susceptibility to complications.

Research question

Does intraoperative CT-navigation improve outcomes in patients with ankylosing spondylitis undergoing surgery?

Methods

A retrospective review was carried out at our centre from 05/2016–06/2021 to identify AS patients presenting with a traumatic spinal fracture, managed surgically with posterior spinal fusion (PSF). Cohorts were categorised and compared for outcomes based on those who underwent PSF with intraoperative CT-navigation versus those surgically managed with traditional intraoperative fluoroscopy.

Results

37 AS patients were identified. 29/37 (78.4%) underwent PSF. Intraoperative navigation was used in 14 (48.3%) cases. Mean age of the entire cohort was 67.6 years. No difference existed between the navigated and non-navigated groups for mean levels fused (5.35 vs 5.07; p = 0.31), length of operation (217.9mins vs 175.3mins; p = 0.07), overall length-of-stay (12 days vs 21.9 days; p = 0.16), patients requiring HDU (3/14 vs 5/15; p = 0.09) or ICU (5/14 vs 9/15; p = 0.10), postoperative neurological improvement (1/14 vs 1/15; p = 0.48) or deterioration (1/14 vs 0/15; p = 0.15), intraoperative complications (2/14 vs 3/15; p = 0.34), postoperative complications 4/14 vs 4/15; p = 0.46), revision surgeries (3/14 vs 1/15; p = 0.16) and 30-day mortality (0/14 vs 0/15).

Conclusion

This is the first study that compares surgical outcomes of navigated vs non-navigated PSFs for AS patients with an acute spinal fracture. Although limited by its retrospective design and sample size, this study highlights the non-inferiority of intraoperative navigation as a surgical aid in a challenging cohort.

引言强直性脊柱炎（AS）急性脊柱骨折患者由于手术解剖困难、易发生并发症，对脊柱外科医生来说是一项挑战。研究问题术中CT导航能否改善接受手术的强直性脊柱炎患者的预后？方法本中心于2016年5月至2021年6月期间进行了一项回顾性研究，以确定出现创伤性脊柱骨折并接受后路脊柱融合术（PSF）手术治疗的AS患者。根据接受术中 CT 导航 PSF 与接受传统术中透视手术治疗的患者的结果，对组群进行分类和比较。29/37（78.4%）名患者接受了 PSF。14例（48.3%）采用术中导航。所有患者的平均年龄为 67.6 岁。在平均融合水平（5.35 vs 5.07；P = 0.31）、手术时间（217.9 分钟 vs 175.3 分钟；P = 0.07）、总住院时间（12 天 vs 21.9 天；p = 0.16）、需要入住 HDU（3/14 vs 5/15；p = 0.09）或 ICU（5/14 vs 9/15；p = 0.10）的患者、术后神经功能改善（1/14 vs 1/15；p = 0.48）或恶化（1/14 vs 0/15；p = 0.15）、术中并发症（2/14 vs 3/15；p = 0.34）、术后并发症4/14 vs 4/15；p = 0.46）、翻修手术（3/14 vs 1/15；p = 0.16）和 30 天死亡率（0/14 vs 0/15）。尽管受限于其回顾性设计和样本量，但该研究强调了在具有挑战性的队列中，术中导航作为手术辅助手段的非劣效性。

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引用次数: 0

Navigating the inevitable convergence of artificial intelligence and surgical training programs 引领人工智能与外科培训计划的必然融合。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-04-05 DOI: 10.1016/j.surge.2024.03.004

Mina Sarofim

引用次数: 0

Prolonged interval to surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A meta-analysis of randomized controlled trials 局部晚期直肠癌新辅助化疗后延长手术时间间隔：随机对照试验荟萃分析。

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-03-22 DOI: 10.1016/j.surge.2024.03.001

P.W. Owens, M. Saeed, N. McCawley, P. Loughlin, D.E. Kearney, J.P. Burke, D.A. McNamara, S.M. Sahebally

Background

Long-course neoadjuvant chemoradiotherapy (NCRT), followed by surgery after an interval of 6–8 weeks, represents standard of care for patients with locally advanced rectal cancer (LARC). Increasing this interval may improve rates of complete pathological response (pCR) and tumour downstaging. We performed a meta-analysis comparing standard (SI, within 8 weeks) versus longer (LI, after 8 weeks) interval from NCRT to surgery.

Methods

PubMed, Embase, and Cochrane databases were searched up to 31 August 2022. Randomized controlled trials (RCTs) comparing SI with LI after NCRT for LARC were included. The primary endpoint was pCR rate. Secondary endpoints included rates of R0 resection, circumferential resection margin positivity (+CRM), TME completeness, lymph node yield (LNY), operative duration, tumour downstaging (TD), sphincter preservation, mortality, postoperative complications, surgical site infection (SSI) and anastomotic leak (AL). Random effects models were used to calculate pooled effect size estimates.

Results

Four RCTs encompassing 867 patients were included. There were 539 males (62.1%). LI was associated with a higher pCR rate (OR 0.61, 95%CI = 0.39–0.95, p = 0.03), and more TD (OR 0.60, 95%CI = 0.37–0.97, p = 0.04) compared to SI. However, there was no difference in rates of R0 resection (p = 0.87), +CRM (p = 0.66), sphincter preservation (p = 0.26), incomplete TME (p = 0.49), LNY (p = 0.55), SSI (p = 0.33), AL (p = 0.20), operative duration (p = 0.07), mortality (p = 0.89) or any surgical complication (p = 0.91).

Conclusions

A LI to surgery after NCRT for LARC increases pCR and TD rates. Local recurrence or survival were not assessed due to unavailable data. We recommend deferring TME until after an interval of 8 weeks following completion of NCRT.

背景：长程新辅助化放疗（NCRT）是局部晚期直肠癌（LARC）患者的标准治疗方法，间隔 6-8 周后进行手术。延长这一间隔可提高完全病理反应（pCR）率和肿瘤降期率。我们进行了一项荟萃分析，比较了从 NCRT 到手术的标准间隔（SI，8 周内）与更长间隔（LI，8 周后）：方法：检索了截至 2022 年 8 月 31 日的 PubMed、Embase 和 Cochrane 数据库。方法：检索了截至 2022 年 8 月 31 日的 PubM、Embed 和 Cochrane 数据库，纳入了 LARC NCRT 后比较 SI 与 LI 的随机对照试验（RCT）。主要终点是 pCR 率。次要终点包括R0切除率、周切缘阳性率（+CRM）、TME完整性、淋巴结率（LNY）、手术持续时间、肿瘤降期（TD）、括约肌保留率、死亡率、术后并发症、手术部位感染（SSI）和吻合口漏（AL）。随机效应模型用于计算汇集效应大小估计值：结果：共纳入了四项研究，涉及 867 名患者。其中有 539 名男性（62.1%）。与SI相比，LI与更高的pCR率（OR 0.61，95%CI = 0.39-0.95，p = 0.03）和更多的TD（OR 0.60，95%CI = 0.37-0.97，p = 0.04）相关。然而，R0切除率（p = 0.87）、+CRM（p = 0.66）、括约肌保留率（p = 0.26）、不完全TME（p = 0.49）、LNY（p = 0.55）、SSI（p = 0.33）、AL（p = 0.20）、手术时间（p = 0.07）、死亡率（p = 0.89）或任何手术并发症（p = 0.91）均无差异：结论：LARC NCRT 后进行手术可提高 pCR 和 TD 率。结论：LARC NCRT 后进行手术可提高 pCR 和 TD 率，但由于数据不详，未对局部复发率或生存率进行评估。我们建议将TME推迟到NCRT结束后8周。

{"title":"Prolonged interval to surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A meta-analysis of randomized controlled trials","authors":"P.W. Owens, M. Saeed, N. McCawley, P. Loughlin, D.E. Kearney, J.P. Burke, D.A. McNamara, S.M. Sahebally","doi":"10.1016/j.surge.2024.03.001","DOIUrl":"10.1016/j.surge.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Long-course neoadjuvant chemoradiotherapy (NCRT), followed by surgery after an interval of 6–8 weeks, represents standard of care for patients with locally advanced rectal cancer (LARC). Increasing this interval may improve rates of complete pathological response (pCR) and tumour downstaging. We performed a meta-analysis comparing standard (SI, within 8 weeks) versus longer (LI, after 8 weeks) interval from NCRT to surgery.</p></div><div><h3>Methods</h3><p>PubMed, Embase, and Cochrane databases were searched up to 31 August 2022. Randomized controlled trials (RCTs) comparing SI with LI after NCRT for LARC were included. The primary endpoint was pCR rate. Secondary endpoints included rates of R0 resection, circumferential resection margin positivity (+CRM), TME completeness, lymph node yield (LNY), operative duration, tumour downstaging (TD), sphincter preservation, mortality, postoperative complications, surgical site infection (SSI) and anastomotic leak (AL). Random effects models were used to calculate pooled effect size estimates.</p></div><div><h3>Results</h3><p>Four RCTs encompassing 867 patients were included. There were 539 males (62.1%). LI was associated with a higher pCR rate (OR 0.61, 95%CI = 0.39–0.95, p = 0.03), and more TD (OR 0.60, 95%CI = 0.37–0.97, p = 0.04) compared to SI. However, there was no difference in rates of R0 resection (p = 0.87), +CRM (p = 0.66), sphincter preservation (p = 0.26), incomplete TME (p = 0.49), LNY (p = 0.55), SSI (p = 0.33), AL (p = 0.20), operative duration (p = 0.07), mortality (p = 0.89) or any surgical complication (p = 0.91).</p></div><div><h3>Conclusions</h3><p>A LI to surgery after NCRT for LARC increases pCR and TD rates. Local recurrence or survival were not assessed due to unavailable data. We recommend deferring TME until after an interval of 8 weeks following completion of NCRT.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 3","pages":"Pages 166-173"},"PeriodicalIF":2.5,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

List of editors 编辑名单

IF 2.5 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2024-03-21 DOI: 10.1016/S1479-666X(24)00022-2

引用次数: 0