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Short-term outcomes depending on type of oesophagojejunostomy in laparoscopic total gastrectomy for gastric cancer: retrospective study based on a Korean Nationwide Survey for Gastric Cancer in 2019. 腹腔镜胃癌全胃切除术中食管空肠吻合术类型的短期疗效:基于2019年韩国全国胃癌调查的回顾性研究。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-10-29 DOI: 10.1093/bjsopen/zrae129
Gun Kang, Jiyeong Kim, Ju-Hee Lee

Background: The study aimed to assess postoperative complication rates of different oesophagojejunostomy (EJ) techniques used in laparoscopic total gastrectomy for gastric cancer.

Methods: A total of 1155 patients who underwent laparoscopic total gastrectomy were retrospectively selected from the data obtained from the Korean Nationwide Survey for gastric cancer in 2019. Morbidity rate was compared between patients who received intracorporeal or extracorporeal EJ using linear or circular staplers during laparoscopic total gastrectomy. The variables of the groups were balanced using the inverse probability of treatment weighting.

Results: Seven hundred and seventy-three patients received intracorporeal EJ using a linear stapler (IL), 137 received intracorporeal EJ using a circular stapler (IC), 134 received extracorporeal EJ using a linear stapler (EL) and 111 received extracorporeal EJ using a circular stapler (EC). The overall complication rates were lower in the extracorporeal group (EL: 13.4% versus EC: 12.6%) compared to the intracorporeal group (IL: 22.6% versus IC: 17.5%) (P = 0.006). Fewer major complications were observed in the extracorporeal group (EL: 1.4% versus EC: 1.8%) compared to the intracorporeal group (IL: 9.4% versus IC: 7.3%) (P = 0.004). There was no significant difference in EJ-related complications between the groups (P = 0.418 in EJ leakage and P = 0.474 in EJ stricture). Multivariable analysis showed that the IL method correlated with more overall and major complications than the extracorporeal method.

Conclusion: The results of this study suggest that despite its widespread use, the IL method is a challenging procedure with higher complication rates than the extracorporeal method. Further high-quality studies are required to confirm the results.

背景:该研究旨在评估腹腔镜胃癌全胃切除术中使用的不同食管空肠吻合术(EJ)术后并发症发生率:该研究旨在评估腹腔镜胃癌全胃切除术中使用的不同食管空肠吻合术(EJ)技术的术后并发症发生率:从2019年韩国全国胃癌调查数据中回顾性选取了1155名接受腹腔镜全胃切除术的患者。比较了在腹腔镜全胃切除术中使用线性或圆形订书机进行体外或体外 EJ 的患者的发病率。各组的变量采用逆概率治疗加权法进行平衡:结果:773 名患者接受了使用线性订书机(IL)的体外 EJ,137 名患者接受了使用圆形订书机(IC)的体外 EJ,134 名患者接受了使用线性订书机(EL)的体外 EJ,111 名患者接受了使用圆形订书机(EC)的体外 EJ。体外组的总体并发症发生率(EL:13.4% 对 EC:12.6%)低于体内组(IL:22.6% 对 IC:17.5%)(P = 0.006)。与体外组(IL:9.4% 对 IC:7.3%)相比,体外组的主要并发症较少(EL:1.4% 对 EC:1.8%)(P = 0.004)。两组之间在 EJ 相关并发症方面没有明显差异(EJ 漏:P = 0.418;EJ 狭窄:P = 0.474)。多变量分析显示,与体外循环方法相比,IL 方法与更多的总体并发症和主要并发症相关:本研究结果表明,尽管IL法被广泛使用,但它是一种具有挑战性的手术,并发症发生率高于体外法。需要更多高质量的研究来证实这些结果。
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引用次数: 0
Effects of the superior mesenteric artery approach versus the no-touch approach during pancreatoduodenectomy on the mobilization of circulating tumour cells and clusters in pancreatic cancer (CETUPANC): randomized clinical trial. 胰十二指肠切除术中肠系膜上动脉入路与不接触入路对胰腺癌循环肿瘤细胞和团块移动的影响(CETUPANC):随机临床试验。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-10-29 DOI: 10.1093/bjsopen/zrae123
Javier Padillo-Ruiz, Cristóbal Fresno, Gonzalo Suarez, Gerardo Blanco, Luis Muñoz-Bellvis, Iago Justo, Maria I García-Domingo, Fabio Ausania, Elena Muñoz-Forner, Alejandro Serrablo, Elena Martin, Luis Díez, Carmen Cepeda, Luis Marin, Jose Alamo, Carmen Bernal, Sheila Pereira, Francisco Calero, Jose Tinoco, Sandra Paterna, Esteban Cugat, Constantino Fondevila, Elisa Diego-Alonso, Diego López-Guerra, Miguel Gomez, Valeria Denninghoff, Luis Sabater

Background: Patients with pancreatic ductal adenocarcinoma present early postoperative systemic metastases, despite complete oncological resection. The aim of this study was to assess two pancreatoduodenectomy approaches with regard to intraoperative circulating tumour cells and cluster mobilization and their potential association with the development of distant metastasis.

Methods: Patients with periampullary tumours who underwent open pancreatoduodenectomy were randomly allocated to either the no-touch approach or the superior mesenteric artery approach. A total of four intraoperative portal vein samples (at the beginning of the intervention, after portal vein disconnection from the tumour, after tumour resection, and before abdominal closure) were collected to measure circulating tumour cells and cluster numbers. Primary outcomes were the intraoperative number of circulating tumour cells and cluster mobilization. Further, their potential impact on 3-year distant metastasis disease-free survival and overall survival was assessed.

Results: A total of 101 patients with periampullary tumours were randomized (51 in the superior mesenteric artery group and 50 in the no-touch group) and 63 patients with pancreatic ductal adenocarcinoma (34 in the superior mesenteric artery group and 29 in the no-touch group) were analysed. Circulating tumour cells and cluster mobilization were similar in both the no-touch group and the superior mesenteric artery group at all time points. There were no significant differences between surgical groups with regard to the median metastasis disease-free survival (12.4 (interquartile range 6.1-not reached) months in the superior mesenteric artery group and 18.1 (interquartile range 12.1-not reached) months in the no-touch group; P = 0.730). Patients with intraoperative cluster mobilization from the beginning to the end of surgery developed significantly more distant metastases within the first year after surgery (P = 0.023). Two intraoperative factors (the superior mesenteric artery approach (P = 0.025) and vein resection (P < 0.001)) were predictive factors for cluster mobilization.

Conclusion: Patients undergoing pancreatoduodenectomy using either the no-touch approach or the superior mesenteric artery approach had similar circulating tumour cells and cluster mobilization and similar overall survival and metastasis disease-free survival. A high intraoperative cluster dissemination during pancreatoduodenectomy was a predictive factor for early metastases in patients with pancreatic ductal adenocarcinoma.

Registration number: NCT03340844 (http://www.clinicaltrials.gov)-CETUPANC trial.

背景:胰腺导管腺癌患者尽管已完全切除肿瘤,但术后仍会出现早期全身转移。本研究旨在评估两种胰十二指肠切除术的术中循环肿瘤细胞和集群动员情况及其与远处转移发生的潜在关系:方法:胰腺周围肿瘤患者接受开腹胰十二指肠切除术后,随机分配到不接触法或肠系膜上动脉法。共收集了四份术中门静脉样本(干预开始时、门静脉与肿瘤断开后、肿瘤切除后和腹部闭合前),以测量循环肿瘤细胞和集群数量。主要结果是术中循环肿瘤细胞数量和集束移动。此外,还评估了它们对3年远处转移无病生存率和总生存率的潜在影响:共对101名胰腺周围肿瘤患者(肠系膜上动脉组51人,无接触组50人)和63名胰腺导管腺癌患者(肠系膜上动脉组34人,无接触组29人)进行了随机分析。在所有时间点,不触及组和肠系膜上动脉组的循环肿瘤细胞和集群移动情况相似。手术组之间的中位无转移生存期无明显差异(肠系膜上动脉组为 12.4 个月(四分位距为 6.1-未达),无接触组为 18.1 个月(四分位距为 12.1-未达);P = 0.730)。术中从手术开始到结束都进行集束移动的患者在术后第一年内发生远处转移的比例明显更高(P = 0.023)。两个术中因素(肠系膜上动脉入路(P = 0.025)和静脉切除(P < 0.001))是集束移动的预测因素:结论:无论是采用不接触法还是肠系膜上动脉法进行胰十二指肠切除术的患者,其循环肿瘤细胞和团块移动情况相似,总生存率和无转移生存率相似。胰十二指肠切除术中术簇的高扩散率是胰腺导管腺癌患者早期转移的预测因素:NCT03340844 (http://www.clinicaltrials.gov)-CETUPANC 试验。
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引用次数: 0
Association of postoperative opioid type with mortality and readmission rates: multicentre retrospective cohort study. 术后阿片类药物类型与死亡率和再入院率的关系:多中心回顾性队列研究。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-10-29 DOI: 10.1093/bjsopen/zrae113
Stasia Winther, Espen Jimenez-Solem, Martin Sillesen

Background: Opioid treatment in postoperative pain management is crucial, but the impact of administration practices on outcomes is unclear. The hypothesis was that prescription trends remained stable over recent years, and that no difference in mortality and readmission risks is associated with prescription strategies.

Method: Electronic health records of surgical episodes in the Capital and Zealand Regions of Denmark from 2017 to 2021 were analysed. All opioids administered during postoperative admission were converted to oral morphine equivalents (OMEQs) and an average daily dose per patient was calculated. The opioid administered in the highest OMEQ dosages is considered the primary opioid strategy for the surgical case. Administration trends were analysed through linear regression, and Cox regression was used to calculate hazard ratios to assess dominant opioid strategies' association with 90-day mortality and readmission rates while controlling for confounders.

Results: A total of 183 317 patients met the inclusion criteria. Prescription trends remained steady during the study period. Multivariable analysis revealed increased readmission risk (HR 1.18, P < 0.001) of tramadol and tapentadol compared to morphine. They exhibited decreased 90-day mortality risk (HR 0.63, P < 0.001). Oxycodone had similar readmission risk (HR 1.009, P = 0.24) but lower 90-day mortality risk (HR 0.68, P < 0.001).

Conclusion: Postoperative in-hospital opioid administration remained stable from 2017 to 2021. Tramadol/tapentadol had a higher risk of readmission but lower mortality risk. Oxycodone had comparable readmission but reduced mortality risk. This study provides a framework for future clinical trials assessing this potential impact of opioids in a targeted manner.

背景:阿片类药物治疗在术后疼痛管理中至关重要,但用药方法对疗效的影响尚不清楚。假设近年来处方趋势保持稳定,死亡率和再入院风险与处方策略没有关联:方法:分析了丹麦首都地区和西兰岛地区 2017 年至 2021 年手术发作的电子健康记录。将术后入院期间使用的所有阿片类药物转换为口服吗啡当量(OMEQs),并计算出每位患者的日平均剂量。以最高 OMEQ 剂量给药的阿片类药物被视为手术病例的主要阿片类药物策略。通过线性回归分析给药趋势,并使用 Cox 回归计算危险比,以评估主要阿片类药物策略与 90 天死亡率和再入院率的关系,同时控制混杂因素:共有 183 317 名患者符合纳入标准。在研究期间,处方趋势保持稳定。多变量分析显示,与吗啡相比,曲马多和他喷他多的再入院风险增加(HR 1.18,P < 0.001)。这两种药物的90天死亡率风险降低(HR 0.63,P < 0.001)。羟考酮的再入院风险相似(HR 1.009,P = 0.24),但90天死亡风险较低(HR 0.68,P < 0.001):从2017年到2021年,术后院内阿片类药物用量保持稳定。曲马多/他喷他多的再入院风险较高,但死亡率风险较低。羟考酮的再入院风险相当,但死亡率风险降低。本研究为今后有针对性地评估阿片类药物潜在影响的临床试验提供了一个框架。
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引用次数: 0
Classifying histopathological growth patterns for resected colorectal liver metastasis with a deep learning analysis. 利用深度学习分析对切除的结直肠肝转移组织病理学生长模式进行分类。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-10-29 DOI: 10.1093/bjsopen/zrae127
Diederik J Höppener, Witali Aswolinskiy, Zhen Qian, David Tellez, Pieter M H Nierop, Martijn Starmans, Iris D Nagtegaal, Michail Doukas, Johannes H W de Wilt, Dirk J Grünhagen, Jeroen A W M van der Laak, Peter Vermeulen, Francesco Ciompi, Cornelis Verhoef

Background: Histopathological growth patterns are one of the strongest prognostic factors in patients with resected colorectal liver metastases. Development of an efficient, objective and ideally automated histopathological growth pattern scoring method can substantially help the implementation of histopathological growth pattern assessment in daily practice and research. This study aimed to develop and validate a deep-learning algorithm, namely neural image compression, to distinguish desmoplastic from non-desmoplastic histopathological growth patterns of colorectal liver metastases based on digital haematoxylin and eosin-stained slides.

Methods: The algorithm was developed using digitalized whole-slide images obtained in a single-centre (Erasmus MC Cancer Institute, the Netherlands) cohort of patients who underwent first curative intent resection for colorectal liver metastases between January 2000 and February 2019. External validation was performed on whole-slide images of patients resected between October 2004 and December 2017 in another institution (Radboud University Medical Center, the Netherlands). The outcomes of interest were the automated classification of dichotomous hepatic growth patterns, distinguishing between desmoplastic hepatic growth pattern and non-desmoplatic growth pattern by a deep-learning model; secondary outcome was the correlation of these classifications with overall survival in the histopathology manual-assessed histopathological growth pattern and those assessed using neural image compression.

Results: Nine hundred and thirty-two patients, corresponding to 3.641 whole-slide images, were reviewed to develop the algorithm and 870 whole-slide images were used for external validation. Median follow-up for the development and the validation cohorts was 43 and 29 months respectively. The neural image compression approach achieved significant discriminatory power to classify 100% desmoplastic histopathological growth pattern with an area under the curve of 0.93 in the development cohort and 0.95 upon external validation. Both the histopathology manual-scored histopathological growth pattern and neural image compression-classified histopathological growth pattern achieved a similar multivariable hazard ratio for desmoplastic versus non-desmoplastic growth pattern in the development cohort (histopathology manual score: 0.63 versus neural image compression: 0.64) and in the validation cohort (histopathology manual score: 0.40 versus neural image compression: 0.48).

Conclusions: The neural image compression approach is suitable for pathology-based classification tasks of colorectal liver metastases.

背景:组织病理学生长模式是切除的结直肠肝转移患者最有力的预后因素之一。开发一种高效、客观和理想的自动组织病理学生长模式评分方法,可大大有助于在日常实践和研究中实施组织病理学生长模式评估。本研究旨在开发和验证一种深度学习算法,即神经图像压缩算法,以基于数字化血红素和伊红染色切片区分结直肠肝转移瘤的去瘤组织病理学生长模式和非去瘤组织病理学生长模式:该算法是利用 2000 年 1 月至 2019 年 2 月期间在单中心(荷兰伊拉斯谟 MC 癌症研究所)队列中获得的数字化全切片图像开发的,该队列中的患者均因结直肠肝转移而接受了首次根治性切除术。外部验证是在另一家机构(荷兰拉德布德大学医学中心)对2004年10月至2017年12月期间切除患者的全切片图像进行的。相关结果是对二分法肝脏生长模式的自动分类,通过深度学习模型区分去瘤细胞肝脏生长模式和非去瘤细胞生长模式;次要结果是这些分类与组织病理学人工评估的组织病理学生长模式和使用神经图像压缩评估的组织病理学生长模式的总生存率的相关性:为开发算法,对 932 例患者(对应 3.641 张整张病理切片图像)进行了审查,并使用 870 张整张病理切片图像进行了外部验证。开发组和验证组的中位随访时间分别为 43 个月和 29 个月。神经图像压缩方法在对 100% 脱鳞组织病理学生长模式进行分类方面具有显著的鉴别力,开发组的曲线下面积为 0.93,外部验证的曲线下面积为 0.95。组织病理学人工评分的组织病理学生长模式和神经图像压缩分类的组织病理学生长模式在开发队列(组织病理学人工评分:0.63,神经图像压缩:0.64)和验证队列(组织病理学人工评分:0.40,神经图像压缩:0.48)中的去瘤组织病理学生长模式与非去瘤组织病理学生长模式的多变量危险比相似:结论:神经图像压缩方法适用于基于病理学的结直肠肝转移分类任务。
{"title":"Classifying histopathological growth patterns for resected colorectal liver metastasis with a deep learning analysis.","authors":"Diederik J Höppener, Witali Aswolinskiy, Zhen Qian, David Tellez, Pieter M H Nierop, Martijn Starmans, Iris D Nagtegaal, Michail Doukas, Johannes H W de Wilt, Dirk J Grünhagen, Jeroen A W M van der Laak, Peter Vermeulen, Francesco Ciompi, Cornelis Verhoef","doi":"10.1093/bjsopen/zrae127","DOIUrl":"10.1093/bjsopen/zrae127","url":null,"abstract":"<p><strong>Background: </strong>Histopathological growth patterns are one of the strongest prognostic factors in patients with resected colorectal liver metastases. Development of an efficient, objective and ideally automated histopathological growth pattern scoring method can substantially help the implementation of histopathological growth pattern assessment in daily practice and research. This study aimed to develop and validate a deep-learning algorithm, namely neural image compression, to distinguish desmoplastic from non-desmoplastic histopathological growth patterns of colorectal liver metastases based on digital haematoxylin and eosin-stained slides.</p><p><strong>Methods: </strong>The algorithm was developed using digitalized whole-slide images obtained in a single-centre (Erasmus MC Cancer Institute, the Netherlands) cohort of patients who underwent first curative intent resection for colorectal liver metastases between January 2000 and February 2019. External validation was performed on whole-slide images of patients resected between October 2004 and December 2017 in another institution (Radboud University Medical Center, the Netherlands). The outcomes of interest were the automated classification of dichotomous hepatic growth patterns, distinguishing between desmoplastic hepatic growth pattern and non-desmoplatic growth pattern by a deep-learning model; secondary outcome was the correlation of these classifications with overall survival in the histopathology manual-assessed histopathological growth pattern and those assessed using neural image compression.</p><p><strong>Results: </strong>Nine hundred and thirty-two patients, corresponding to 3.641 whole-slide images, were reviewed to develop the algorithm and 870 whole-slide images were used for external validation. Median follow-up for the development and the validation cohorts was 43 and 29 months respectively. The neural image compression approach achieved significant discriminatory power to classify 100% desmoplastic histopathological growth pattern with an area under the curve of 0.93 in the development cohort and 0.95 upon external validation. Both the histopathology manual-scored histopathological growth pattern and neural image compression-classified histopathological growth pattern achieved a similar multivariable hazard ratio for desmoplastic versus non-desmoplastic growth pattern in the development cohort (histopathology manual score: 0.63 versus neural image compression: 0.64) and in the validation cohort (histopathology manual score: 0.40 versus neural image compression: 0.48).</p><p><strong>Conclusions: </strong>The neural image compression approach is suitable for pathology-based classification tasks of colorectal liver metastases.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Reported outcomes in studies of intermittent claudication - first step toward a core outcome set: systematic review. 间歇性跛行研究中的报告结果--迈向核心结果集的第一步:系统综述。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-10-29 DOI: 10.1093/bjsopen/zrae126
Akam Shwan, Segun Lamidi, Calvin Chan, Elizabeth Daniels, Charlie Song-Smith, Lydia Hanna, Viknesh Sounderajah, John S M Houghton, Rob D Sayers

Introduction: This review aimed to compile an exhaustive list of all outcome measures and identify different characteristics of the outcomes reported in studies of intermittent claudication as the first step in developing a core outcome set for intermittent claudication.

Method: Medline and Embase were searched for all studies including individuals with intermittent claudication and reporting ≥1 outcome from January 2015 to August 2024. Abstract, full text screening and data extraction were performed by two investigators independently. All reported outcome measures were extracted verbatim and categorized by Dodd's domains (Core Outcome Measures in Effectiveness Trials registration: COMIC Study, 1590; https://www.comet-initiative.org/Studies/Details/1590).

Results: 4985 studies were screened and 408 were included. A total of 541 unique outcomes across 25 Dodd's domains were identified. Ankle-brachial pressure index was the most frequently reported outcome. Among the 541 unique outcomes, 386 outcomes were only reported once. Only 38.9% of the studies exclusively included patients with intermittent claudication. Patient-reported outcomes were reported in 36.2% of studies. There were wide variations in the definition of commonly used outcome measures (for example, major adverse limb event and primary patency) across different studies.

Conclusion: There is substantial heterogeneity in reported outcomes in studies of intermittent claudication. Most reported outcomes are clinical/physiology oriented rather than patient centred. Development of a core outcome set for intermittent claudication is vital to improve and standardize reporting in future research.

导言:本综述旨在汇编一份所有结果测量的详尽清单,并确定间歇性跛行研究中报告的结果的不同特征,作为制定间歇性跛行核心结果集的第一步:方法:在 Medline 和 Embase 中检索了 2015 年 1 月至 2024 年 8 月期间所有包含间歇性跛行患者且报告结果≥1 项的研究。摘要、全文筛选和数据提取由两名研究人员独立完成。所有报告的结果指标均被逐字提取,并按多德领域(有效性试验中的核心结果指标注册:COMIC研究,1590;https://www.comet-initiative.org/Studies/Details/1590)。结果:结果:共筛选出 4985 项研究,其中 408 项被纳入。结果:共筛选出 4985 项研究,纳入 408 项研究,共确定了 25 个多德领域的 541 项独特结果。踝肱压力指数是最常报告的结果。在这 541 项独特结果中,有 386 项结果只报告过一次。只有 38.9% 的研究专门纳入了间歇性跛行患者。36.2%的研究报告了患者报告的结果。不同研究对常用结果指标(如肢体主要不良事件和主要通畅率)的定义存在很大差异:结论:间歇性跛行研究中报告的结果存在很大的异质性。大多数报告的结果以临床/生理学为导向,而不是以患者为中心。制定间歇性跛行的核心结果集对于改善和规范未来研究的报告至关重要。
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引用次数: 0
Impact of radiotherapy on quality of life in patients with rectal cancer. 放疗对直肠癌患者生活质量的影响。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-09-03 DOI: 10.1093/bjsopen/zrae105
Patricia Tejedor, Quentin Denost
{"title":"Impact of radiotherapy on quality of life in patients with rectal cancer.","authors":"Patricia Tejedor, Quentin Denost","doi":"10.1093/bjsopen/zrae105","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae105","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11387962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial. 用超氧化溶液进行腹膜和伤口灌洗对穿孔性阑尾炎开腹阑尾切除术(PLaSSo)后手术部位感染的影响:随机临床试验。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-09-03 DOI: 10.1093/bjsopen/zrae121
Harivinthan Sellappan, Dinesh Alagoo, Christina Loo, Kaesarina Vijian, Rohamini Sibin, Jitt Aun Chuah

Background: Surgical-site infection following open appendicectomy for perforated appendicitis increases length of hospital stay and treatment costs while compromising patients' quality of life. Data from randomized clinical trials (RCTs) evaluating the role of super-oxidized solution in perforated appendicitis are lacking. The study objective was to determine the effect of peritoneal and wound lavage with super-oxidized solution in reducing risk of surgical-site infection following open appendicectomy for perforated appendicitis.

Methods: In this multicentre RCT conducted between September 2020 and March 2022, patients aged 13 years and older with perforated appendicitis undergoing open appendicectomy were randomly assigned to receive peritoneal and wound lavage with either super-oxidized solution or normal saline. The primary outcome was surgical-site infection within 30 days after surgery. Randomization was computer-generated, with allocation concealment by opaque, sequentially numbered, sealed envelope. The patients, surgeons, outcome assessors and statisticians performing the analysis were blinded to treatment assigned.

Results: A total of 102 consecutive patients (51 in the super-oxidized solution group and 51 in the normal saline group) were randomized and included in the intention-to-treat analysis. The super-oxidized solution group showed a significant reduction in overall surgical-site infection (8 (15.6%) versus 19 (37.2%); relative risk (RR) 0.42; 95% c.i. 0.20 to 0.87; P = 0.014), and superficial surgical-site infection (5 (9.8%) versus 18 (35.3%); RR 0.28; 95% c.i. 0.11 to 0.69; P = 0.002), with a number-needed-to-treat of four patients. There were no adverse events in either group.

Conclusions: Peritoneal and wound lavage with super-oxidized solution is superior to normal saline in preventing surgical-site infection after open appendicectomy for perforated appendicitis.

Trial registration: ClinicalTrial.gov Identifier: NCT04512196.

背景:开腹阑尾切除术治疗穿孔性阑尾炎后的手术部位感染会增加住院时间和治疗费用,同时影响患者的生活质量。目前还缺乏随机临床试验(RCT)的数据来评估超氧化物歧化溶液在穿孔性阑尾炎中的作用。本研究旨在确定使用超氧化物溶液进行腹膜和伤口灌洗对降低阑尾炎穿孔开放性切除术后手术部位感染风险的效果:在 2020 年 9 月至 2022 年 3 月期间进行的这项多中心 RCT 中,年龄在 13 岁及以上、接受开腹阑尾切除术的穿孔性阑尾炎患者被随机分配接受超氧化物溶液或生理盐水进行腹膜和伤口灌洗。主要结果是术后30天内的手术部位感染。随机化由计算机生成,并通过不透明、按顺序编号、密封的信封进行分配隐藏。患者、外科医生、结果评估人员和进行分析的统计人员对所分配的治疗方案均为盲人:共有102名患者(超氧化物歧化溶液组51人,生理盐水组51人)被随机分配并纳入意向治疗分析。超氧化物溶液组显著降低了总体手术部位感染(8 例(15.6%)对 19 例(37.2%);相对风险 (RR) 0.42;95% c.i. 0.20 至 0.87;P = 0.014)和浅表手术部位感染(5 例(9.8%)对 18 例(35.3%);RR 0.28;95% c.i. 0.11 至 0.69;P = 0.002),需要治疗的患者人数为 4 人。两组患者均未出现不良反应:结论:在穿孔性阑尾炎开腹阑尾切除术后,用超氧化溶液进行腹腔和伤口灌洗在预防手术部位感染方面优于生理盐水:试验注册:ClinicalTrial.gov Identifier:试验注册:ClinicalTrial.gov Identifier:NCT04512196。
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引用次数: 0
Automated analysis of operative video in surgical training: scoping review. 手术培训中的手术视频自动分析:范围界定综述。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-09-03 DOI: 10.1093/bjsopen/zrae124
Lachlan Dick, Connor P Boyle, Richard J E Skipworth, Douglas S Smink, Victoria Ruth Tallentire, Steven Yule

Background: There is increasing availability of operative video for use in surgical training. Emerging technologies can now assess video footage and automatically generate metrics that could be harnessed to improve the assessment of operative performance. However, a comprehensive understanding of which technology features are most impactful in surgical training is lacking. The aim of this scoping review was to explore the current use of automated video analytics in surgical training.

Methods: PubMed, Scopus, the Web of Science, and the Cochrane database were searched, to 29 September 2023, following PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Search terms included 'trainee', 'video analytics', and 'education'. Articles were screened independently by two reviewers to identify studies that applied automated video analytics to trainee-performed operations. Data on the methods of analysis, metrics generated, and application to training were extracted.

Results: Of the 6736 articles screened, 13 studies were identified. Computer vision tracking was the common method of video analysis. Metrics were described for processes (for example movement of instruments), outcomes (for example intraoperative phase duration), and critical safety elements (for example critical view of safety in laparoscopic cholecystectomy). Automated metrics were able to differentiate between skill levels (for example consultant versus trainee) and correlated with traditional methods of assessment. There was a lack of longitudinal application to training and only one qualitative study reported the experience of trainees using automated video analytics.

Conclusion: The performance metrics generated from automated video analysis are varied and encompass several domains. Validation of analysis techniques and the metrics generated are a priority for future research, after which evidence demonstrating the impact on training can be established.

背景:用于外科培训的手术视频越来越多。新兴技术现在可以评估视频片段并自动生成衡量标准,这些标准可用于改进手术表现评估。然而,目前还缺乏对哪些技术功能对外科培训影响最大的全面了解。本范围综述旨在探讨自动视频分析技术目前在外科培训中的应用:根据范围界定综述的 PRISMA 扩展(PRISMA-ScR)指南,对 PubMed、Scopus、Web of Science 和 Cochrane 数据库进行了检索,检索期至 2023 年 9 月 29 日。检索词包括 "学员"、"视频分析 "和 "教育"。文章由两名审稿人独立筛选,以确定将自动视频分析技术应用于学员操作的研究。结果:结果:在筛选出的 6736 篇文章中,确定了 13 项研究。计算机视觉跟踪是常用的视频分析方法。对过程(如器械移动)、结果(如术中阶段持续时间)和关键安全要素(如腹腔镜胆囊切除术中的关键安全观)进行了描述。自动化指标能够区分不同的技能水平(例如顾问与实习生),并与传统的评估方法相关联。缺乏对培训的纵向应用,只有一项定性研究报告了学员使用自动视频分析的经验:结论:自动视频分析产生的绩效指标多种多样,涵盖多个领域。对分析技术和生成的指标进行验证是未来研究的重点,之后可以建立证据来证明其对培训的影响。
{"title":"Automated analysis of operative video in surgical training: scoping review.","authors":"Lachlan Dick, Connor P Boyle, Richard J E Skipworth, Douglas S Smink, Victoria Ruth Tallentire, Steven Yule","doi":"10.1093/bjsopen/zrae124","DOIUrl":"10.1093/bjsopen/zrae124","url":null,"abstract":"<p><strong>Background: </strong>There is increasing availability of operative video for use in surgical training. Emerging technologies can now assess video footage and automatically generate metrics that could be harnessed to improve the assessment of operative performance. However, a comprehensive understanding of which technology features are most impactful in surgical training is lacking. The aim of this scoping review was to explore the current use of automated video analytics in surgical training.</p><p><strong>Methods: </strong>PubMed, Scopus, the Web of Science, and the Cochrane database were searched, to 29 September 2023, following PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Search terms included 'trainee', 'video analytics', and 'education'. Articles were screened independently by two reviewers to identify studies that applied automated video analytics to trainee-performed operations. Data on the methods of analysis, metrics generated, and application to training were extracted.</p><p><strong>Results: </strong>Of the 6736 articles screened, 13 studies were identified. Computer vision tracking was the common method of video analysis. Metrics were described for processes (for example movement of instruments), outcomes (for example intraoperative phase duration), and critical safety elements (for example critical view of safety in laparoscopic cholecystectomy). Automated metrics were able to differentiate between skill levels (for example consultant versus trainee) and correlated with traditional methods of assessment. There was a lack of longitudinal application to training and only one qualitative study reported the experience of trainees using automated video analytics.</p><p><strong>Conclusion: </strong>The performance metrics generated from automated video analysis are varied and encompass several domains. Validation of analysis techniques and the metrics generated are a priority for future research, after which evidence demonstrating the impact on training can be established.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11482280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Impact of an appendicolith and its characteristics on the severity of acute appendicitis. 阑尾结石及其特征对急性阑尾炎严重程度的影响。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-09-03 DOI: 10.1093/bjsopen/zrae093
Sami Sula, Timo Paananen, Ville Tammilehto, Saija Hurme, Anne Mattila, Tuomo Rantanen, Tero Rautio, Tarja Pinta, Suvi Sippola, Jussi M Haijanen, Paulina Salminen

Background: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity.

Methods: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated-including perforation, gangrene, an abscess, or a tumour) was determined for all patients.

Results: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis.

Conclusion: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.

背景:据报道,对于未使用计算机断层扫描(CT)诊断出阑尾结石的无并发症急性阑尾炎,抗生素是一种高效、安全的治疗方案。本研究旨在评估 CT 诊断阑尾结石及其特征与阑尾炎严重程度的关系:对 2017 年 4 月至 2018 年 11 月间入组的疑似急性阑尾炎的大型前瞻性患者队列进行了回顾性回顾。初步分析评估了 CT 诊断阑尾结石与复杂性急性阑尾炎的相关性;然后,根据 CT 图像的可用性,分析了一部分患者阑尾结石特征与阑尾炎严重程度的相关性。所有患者的阑尾炎最终评估结果(无并发症或并发症--包括穿孔、坏疽、脓肿或肿瘤)均已确定:在 3512 名符合条件的患者中,选出了 3085 名阑尾炎患者,并纳入了 380 名有阑尾结石且有 CT 图像可供重新评估的患者。在 3085 名经 CT 诊断为急性阑尾炎的患者中,有 1101 人(35.7%)同时患有急性阑尾炎和阑尾结石,其中有 519 人(47.1%)患有复杂性急性阑尾炎。在没有阑尾结石的患者(1984 人)中,426 人(21.5%)患有复杂性阑尾炎(P < 0.001)。重新评估380名患者的CT图像显示,阑尾结石直径较大(OR = 1.15 (95% c.i. 1.06 to 1.25);P < 0.001)、阑尾结石位于阑尾底部(55.1% 对 44.9%;P = 0.008)和阑尾结石周围阑尾壁异质强化(68.4% 对 31.6%;P < 0.001)与并发急性阑尾炎的风险增加有关:结论:急性阑尾炎患者出现阑尾结石与并发阑尾炎的风险相关。结论:急性阑尾炎患者出现阑尾结石与并发阑尾炎的风险相关,阑尾结石直径较大或结石位于阑尾底部会进一步增加并发阑尾炎的风险。
{"title":"Impact of an appendicolith and its characteristics on the severity of acute appendicitis.","authors":"Sami Sula, Timo Paananen, Ville Tammilehto, Saija Hurme, Anne Mattila, Tuomo Rantanen, Tero Rautio, Tarja Pinta, Suvi Sippola, Jussi M Haijanen, Paulina Salminen","doi":"10.1093/bjsopen/zrae093","DOIUrl":"10.1093/bjsopen/zrae093","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity.</p><p><strong>Methods: </strong>A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated-including perforation, gangrene, an abscess, or a tumour) was determined for all patients.</p><p><strong>Results: </strong>Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis.</p><p><strong>Conclusion: </strong>The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery. 心率变异性是血管外科手术中外科医生压力的动态标记。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-09-03 DOI: 10.1093/bjsopen/zrae097
Calvin D De Louche, Manish Mandal, Lee Fernandes, Jason Lawson, Colin D Bicknell, Anna L Pouncey

Background: A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery.

Methods: A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress.

Results: Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress.

Conclusion: Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty.

背景介绍外科医生在进行手术时会经历较高的压力水平。急性压力与认知负荷过重有关,会导致手术效果恶化。慢性压力对外科医生的健康构成重大风险。识别术中压力可能有助于制定预防策略,减轻外科医生的压力,从而改善患者的预后。本研究旨在评估使用心率变异性作为血管手术中压力标志物的可行性:共有 11 名资深外科医生在进行三种不同的血管外科手术时接受了评估。心率变异性指标(低频与高频比值和正常-正常间期的标准偏差)是在预定的手术表现点从单导联心电图描记中确定的。状态-特质焦虑量表-6 是一种经过验证的压力工具,用于评估外科医生报告的压力。此外,还收集了手术难度的主观报告。单因素方差分析比较了关键绩效点与基线的心率变异性。皮尔逊系数评估了心率变异性与主观压力之间的相关性:收集了六例颈动脉内膜切除术、六例开放式腹主动脉瘤修补术和五例下肢搭桥术的数据。在所有手术的关键执行点都观察到了心率变异指标,表明压力明显增大。执行同一手术的不同外科医生的压力峰值是一致的。心率变异指标与主观状态-特质焦虑量表-6 压力报告之间存在明显相关性(r = 0.768,P = 结论:心率变异性可能是评估血管手术中术中压力和认知负荷的一种可行方法,可用于评估手术室干预措施(如超时)是否能减轻手术困难区域的压力。
{"title":"Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery.","authors":"Calvin D De Louche, Manish Mandal, Lee Fernandes, Jason Lawson, Colin D Bicknell, Anna L Pouncey","doi":"10.1093/bjsopen/zrae097","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae097","url":null,"abstract":"<p><strong>Background: </strong>A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery.</p><p><strong>Methods: </strong>A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress.</p><p><strong>Results: </strong>Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress.</p><p><strong>Conclusion: </strong>Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
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