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Piperacillin/tazobactam for surgical prophylaxis during pancreatoduodenectomy: meta-analysis. 哌拉西林/他唑巴坦用于胰十二指肠切除术期间的手术预防:荟萃分析。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae066
Jayant Kumar, Isabella Reccia, Adriano Carneiro, Mauro Podda, Francesco Virdis, Nikolaos Machairas, David Nasralla, Ramesh P Arasaradnam, Kenneth Poon, Christopher J Gannon, John J Fung, Nagy Habib, Omar Llaguna

Background: Pancreatoduodenectomy is associated with an increased incidence of surgical-site infections, often leading to a significant rise in morbidity and mortality. This trend underlines the inadequacy of traditional antibiotic prophylaxis strategies. Hence, the aim of this meta-analysis was to assess the outcomes of antimicrobial prophylaxis, comparing piperacillin/tazobactam with traditional antibiotics.

Methods: Upon registering in PROSPERO, the international prospective register of systematic reviews (CRD42023479100), a systematic search of various databases was conducted over the interval 2000-2023. This inclusive search encompassed a wide range of study types, including prospective and retrospective cohorts and RCTs. The subsequent data analysis was carried out utilizing RevMan 5.4.

Results: A total of eight studies involving 2382 patients who underwent pancreatoduodenectomy and received either piperacillin/tazobactam (1196 patients) or traditional antibiotics (1186 patients) as antibiotic prophylaxis during surgery were included in the meta-analysis. Patients in the piperacillin/tazobactam group had significantly reduced incidences of surgical-site infections (OR 0.43 (95% c.i. 0.30 to 0.62); P < 0.00001) and major surgical complications (Clavien-Dindo grade greater than or equal to III) (OR 0.61 (95% c.i. 0.45 to 0.81); P = 0.0008). Subgroup analysis of surgical-site infections highlighted significantly reduced incidences of superficial surgical-site infections (OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02) and organ/space surgical-site infections (OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004) in the piperacillin/tazobactam group. Further, the analysis demonstrated significantly lower incidences of clinically relevant postoperative pancreatic fistulas (grades B and C) (OR 0.67 (95% c.i. 0.53 to 0.83); P = 0.0003) and mortality (OR 0.51 (95% c.i. 0.28 to 0.91); P = 0.02) in the piperacillin/tazobactam group.

Conclusion: Piperacillin/tazobactam as antimicrobial prophylaxis significantly lowers the risk of postoperative surgical-site infections, major surgical complications (complications classified as Clavien-Dindo grade greater than or equal to III), clinically relevant postoperative pancreatic fistulas (grades B and C), and mortality, hence supporting the implementation of piperacillin/tazobactam for surgical prophylaxis in current practice.

背景:胰十二指肠切除术与手术部位感染发生率增加有关,往往导致发病率和死亡率显著上升。这一趋势凸显了传统抗生素预防策略的不足。因此,本荟萃分析旨在通过比较哌拉西林/他唑巴坦与传统抗生素,评估抗菌药预防的效果:在国际系统综述前瞻性登记册 PROSPERO(CRD42023479100)中登记后,对 2000-2023 年间的各种数据库进行了系统检索。该检索涵盖了多种研究类型,包括前瞻性和回顾性队列研究以及研究性临床试验。随后利用 RevMan 5.4 进行了数据分析:荟萃分析共纳入了 8 项研究,涉及 2382 例接受胰十二指肠切除术的患者,这些患者在手术期间接受了哌拉西林/他唑巴坦(1196 例)或传统抗生素(1186 例)作为抗生素预防。哌拉西林/他唑巴坦组患者的手术部位感染(OR 0.43 (95% c.i. 0.30 to 0.62);P < 0.00001)和主要手术并发症(Clavien-Dindo 分级大于或等于 III)(OR 0.61 (95% c.i. 0.45 to 0.81);P = 0.0008)发生率明显降低。手术部位感染亚组分析显示,哌拉西林/他唑巴坦组的浅表手术部位感染(OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02)和器官/间隙手术部位感染(OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004)发生率明显降低。此外,分析表明哌拉西林/他唑巴坦组术后临床相关的胰瘘(B级和C级)发生率(OR值为0.67(95% 置信区间为0.53-0.83);P = 0.0003)和死亡率(OR值为0.51(95% 置信区间为0.28-0.91);P = 0.02)均明显低于哌拉西林/他唑巴坦组:结论:哌拉西林/他唑巴坦作为抗菌药物预防可显著降低术后手术部位感染、主要手术并发症(Clavien-Dindo分级大于或等于III级的并发症)、临床相关的术后胰瘘(B级和C级)和死亡率的风险,因此支持在当前实践中将哌拉西林/他唑巴坦用于手术预防。
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引用次数: 0
Feasibility of robotic-assisted surgery in advanced rectal cancer: a multicentre prospective phase II study (VITRUVIANO trial). 机器人辅助手术治疗晚期直肠癌的可行性:多中心前瞻性 II 期研究(VITRUVIANO 试验)。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae048
Atsushi Hamabe, Ichiro Takemasa, Masanori Kotake, Daisuke Nakano, Suguru Hasegawa, Akio Shiomi, Masakatsu Numata, Kazuhiro Sakamoto, Kei Kimura, Tsunekazu Hanai, Takeshi Naitoh, Yosuke Fukunaga, Yusuke Kinugasa, Jun Watanabe, Junichiro Kawamura, Mayumi Ozawa, Koji Okabayashi, Shuichiro Matoba, Yoshinao Takano, Mamoru Uemura, Yukihide Kanemitsu, Yoshiharu Sakai, Masahiko Watanabe

Background: The potential benefits of robotic-assisted compared with laparoscopic surgery for locally advanced cancer have not been sufficiently proven by prospective studies. One factor is speculated to be the lack of strict surgeon criteria. The aim of this study was to assess outcomes for robotic surgery in patients with locally advanced rectal cancer with strict surgeon experience criteria.

Methods: A criterion was set requiring surgeons to have performed more than 40 robotically assisted operations for rectal cancer. Between March 2020 and May 2022, patients with rectal cancer (distance from the anal verge of 12 cm or less, cT2-T4a, cN0-N3, cM0, or cT1-T4a, cN1-N3, cM0) were registered. The primary endpoint was the rate positive circumferential resection margin (CRM) from the pathological specimen. Secondary endpoints were surgical outcomes, pathological results, postoperative complications, and longterm outcomes.

Results: Of the 321 registered patients, 303 were analysed, excluding 18 that were ineligible. At diagnosis: stage I (n = 68), stage II (n = 84) and stage III (n = 151). Neoadjuvant therapy was used in 56 patients. There were no conversions to open surgery. The median console time to rectal resection was 170 min, and the median blood loss was 5 ml. Fourteen patients had a positive CRM (4.6%). Grade III-IV postoperative complications were observed in 13 patients (4.3%).

Conclusion: Robotic-assisted surgery is feasible for locally advanced rectal cancer when strict surgeon criteria are used.

背景:与腹腔镜手术相比,机器人辅助手术治疗局部晚期癌症的潜在优势尚未得到前瞻性研究的充分证实。据推测,其中一个因素是缺乏严格的外科医生标准。本研究的目的是在严格的外科医生经验标准下评估局部晚期直肠癌患者的机器人手术效果:方法:设定的标准是外科医生必须实施过 40 例以上的直肠癌机器人辅助手术。在 2020 年 3 月至 2022 年 5 月期间,登记了直肠癌患者(距离肛门边缘 12 厘米或以下、cT2-T4a、cN0-N3、cM0 或 cT1-T4a、cN1-N3、cM0)。主要终点是病理标本的周缘切除边缘(CRM)阳性率。次要终点是手术结果、病理结果、术后并发症和长期疗效:在 321 名登记患者中,除去 18 名不符合条件的患者,共对 303 名患者进行了分析。诊断时:I期(68人)、II期(84人)和III期(151人)。56名患者接受了新辅助治疗。没有患者转为开放手术。直肠切除术的中位控制时间为170分钟,中位失血量为5毫升。14名患者的CRM呈阳性(4.6%)。13名患者(4.3%)出现了III-IV级术后并发症:结论:如果严格遵守外科医生的标准,机器人辅助手术对局部晚期直肠癌是可行的。
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引用次数: 0
Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger. 为 60 岁或以下的 DeBakey 1 型主动脉夹层患者实施主动脉弓手术。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae047
Fausto Biancari, Javier Rodriguez Lega, Giovanni Mariscalco, Sven Peterss, Joscha Buech, Antonio Fiore, Andrea Perrotti, Andreas Rukosujew, Angel G Pinto, Till Demal, Konrad Wisniewski, Marek Pol, Giuseppe Gatti, Igor Vendramin, Mauro Rinaldi, Robert Pruna-Guillen, Dario Di Perna, Zein El-Dean, Hiwa Sherzad, Francesco Nappi, Mark Field, Matteo Pettinari, Mikko Jormalainen, Angelo M Dell'Aquila, Francesco Onorati, Eduard Quintana, Tatu Juvonen, Timo Mäkikallio

Background: Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study.

Methods: The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta.

Results: Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score-matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172).

Conclusions: In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT04831073.

背景:延长主动脉修补术被认为是 DeBakey 1 型主动脉夹层手术长期耐久性的关键问题。年轻患者由于预期寿命长,主动脉变性的风险可能更高。本研究调查了这些患者主动脉手术的早期结果和耐久性:本次分析的对象是 2005 年至 2021 年期间在欧洲 18 个心脏外科中心接受急性 DeBakey 1 型主动脉夹层手术修复的 60 岁以下患者。患者采用传统技术或冷冻象鼻技术接受了升主动脉修复术或全主动脉弓修复术。主要结果是远端主动脉5年累计再手术发生率:结果:共有 915 名患者接受了升主动脉修复手术,284 名患者接受了全主动脉弓修复手术。128名患者接受了冷冻象鼻手术。在245对倾向得分匹配的患者中,与升主动脉修复术相比,全主动脉弓修复术并没有降低远端主动脉再手术率(5年累计发生率,6.7%对6.7%,亚分布危险比1.127,95% c.i.0.523对2.427)。全主动脉弓修补术增加了术后中风/全脑缺血(25.7% 对 18.4%,P = 0.050)和透析(19.6% 对 12.7%,P = 0.003)的发生率。升主动脉修补术和全主动脉弓修补术的五年死亡率相当(22.8% 对 27.3%,P = 0.172):结论:对于60岁以下的DeBakey 1型主动脉夹层患者,与升主动脉修复术相比,全主动脉弓置换术并不能降低5年后远端主动脉手术的发生率。在可行的情况下,升主动脉修补术治疗 DeBakey 1 型主动脉夹层可获得令人满意的早期和中期疗效:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT04831073。
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引用次数: 0
Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study. 局部晚期中/低位直肠癌的机器人、经肛门和腹腔镜全直肠系膜切除术:欧洲多中心倾向评分匹配研究。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae044
Nicola de'Angelis, Francesco Marchegiani, Aleix Martínez-Pérez, Alberto Biondi, Salvatore Pucciarelli, Carlo Alberto Schena, Gianluca Pellino, Miquel Kraft, Annabel S van Lieshout, Luca Morelli, Alain Valverde, Renato Micelli Lupinacci, Segundo A Gómez-Abril, Roberto Persiani, Jurriaan B Tuynman, Eloy Espin-Basany, Frederic Ris

Background: Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME).

Methods: Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival.

Results: A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival.

Conclusion: In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.

背景:全直肠系膜切除术(TME)是低位/中位局部晚期直肠癌的标准手术。本研究的目的是比较三种带主吻合器的 TME 微创手术方法(腹腔镜 TME、机器人 TME 和经肛门 TME):分析了2013年至2022年期间在欧洲核磁共振和直肠癌手术III(EuMaRCS-III)数据库的专家中心根据标准化技术接受腹腔镜TME、机器人TME或经肛门TME手术的患者记录。采用倾向评分匹配法对三组患者的并发症发生率(主要结果)、转归率、术后恢复和生存率进行了比较:共纳入468名患者(平均(s.d.)年龄为64.1(11)岁),其中190名(40.6%)患者接受了腹腔镜TME,141名(30.1%)患者接受了机器人TME,137名(29.3%)患者接受了经肛门TME。倾向得分匹配后的比较分析表明,与机器人TME(OR 1.80,95% c.i.1.11-2.91)和经肛门TME(OR 2.87,95% c.i.1.72-4.80)相比,腹腔镜TME的术后并发症发生率更高。与腹腔镜 TME(8.8%)和经肛门 TME(8.1%)相比,机器人 TME 的 A 级吻合口漏率较低(2%)(P = 0.031)。与腹腔镜TME(8.8%)相比,机器人TME(1.4%)和经肛门TME(0.7%)转为开腹手术的比例都较低(P < 0.001)。接受经肛门 TME 治疗的患者排便时间和住院时间更短(P = 0.003 和 0.001)。手术时间、术中并发症、失血量、死亡率、再入院率、R0切除率或存活率均无差异:在这项针对局部晚期直肠癌患者的多中心、回顾性、倾向评分匹配队列研究中,较新的微创方法(机器人TME和经肛门TME)与腹腔镜TME相比,疗效更佳。
{"title":"Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study.","authors":"Nicola de'Angelis, Francesco Marchegiani, Aleix Martínez-Pérez, Alberto Biondi, Salvatore Pucciarelli, Carlo Alberto Schena, Gianluca Pellino, Miquel Kraft, Annabel S van Lieshout, Luca Morelli, Alain Valverde, Renato Micelli Lupinacci, Segundo A Gómez-Abril, Roberto Persiani, Jurriaan B Tuynman, Eloy Espin-Basany, Frederic Ris","doi":"10.1093/bjsopen/zrae044","DOIUrl":"10.1093/bjsopen/zrae044","url":null,"abstract":"<p><strong>Background: </strong>Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME).</p><p><strong>Methods: </strong>Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival.</p><p><strong>Results: </strong>A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival.</p><p><strong>Conclusion: </strong>In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141160651","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
Lymphatic spread patterns in young versus elderly patients with stage III colon cancer. 年轻与老年 III 期结肠癌患者的淋巴扩散模式。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae036
Jihyung Song, Kozo Kataoka, Manabu Inoue, Takeshi Yamada, Manabu Shiozawa, Naohito Beppu, Sho Kuriyama, Takeshi Suto, Nobuhisa Matsuhashi, Yusuke Sakura, Akiyoshi Kanazawa, Hiroyasu Kagawa, Yukihide Kanemitsu, Wim Ceelen, Masataka Ikeda

Background: The anatomical pattern of lymph nodes spread differs between young (aged 45 years or younger) and elderly (aged 80 years or older) patients with stage III colon cancer and is poorly investigated.

Methods: Two groups of patients (young and elderly) with stage III colon cancer who underwent upfront extensive (D3) lymphadenectomy at eight Japanese centres between 1998 and 2018 were retrospectively analysed. The primary endpoint was the proportion of positive central lymph nodes. The lymph nodes spreading pattern and its prognostic impact on recurrence-free survival and overall survival in the two groups were also compared.

Results: Two hundred and ten young patients and 348 elderly patients were identified and compared. The total number of lymph nodes harvested and the total number of invaded lymph nodes were significantly higher in younger patients compared with elderly patients (median of 31.5 (3-151) versus 21 (3-116), P < 0.001 and median of 3 (1-21) versus 2 (1-25), P < 0.001 respectively). The proportion of positive central lymph nodes were higher in younger patients than in elderly patients (9.52% (95% c.i. 6.24 to 14.2%) versus 4.59% (95% c.i. 2.84 to 7.31%), P = 0.012). In multivariate models for recurrence-free survival, central lymph nodes invasion were identified as a poor prognostic factor in younger patients (HR 5.21 (95% c.i. 1.76 to 15.39)) but not in elderly patients (HR 1.73 (95% c.i. 0.80 to 3.76)).

Conclusion: Young patients with stage III colon cancer have a higher risk of central lymph nodes invasion, suggesting a more aggressive disease biology. The presence of central lymph nodes invasion are associated with a worse outcome in young patients.

背景:年轻(45 岁或以下)和年长(80 岁或以上)的 III 期结肠癌患者淋巴结扩散的解剖模式不同,而且研究很少:年轻(45 岁或以下)和年长(80 岁或以上)的 III 期结肠癌患者淋巴结扩散的解剖模式不同,且研究较少:方法:对1998年至2018年期间在日本8个中心接受前期广泛(D3)淋巴结切除术的两组III期结肠癌患者(年轻人和老年人)进行了回顾性分析。主要终点是中央淋巴结阳性的比例。同时还比较了两组患者的淋巴结扩散模式及其对无复发生存率和总生存率的预后影响:结果:共发现并比较了 210 名年轻患者和 348 名老年患者。年轻患者收获的淋巴结总数和受侵淋巴结总数明显高于老年患者(中位数分别为 31.5(3-151)对 21(3-116),P<0.001;中位数分别为 3(1-21)对 2(1-25),P<0.001)。年轻患者中央淋巴结阳性的比例高于老年患者(9.52%(95% 置信区间:6.24 至 14.2%)对 4.59%(95% 置信区间:2.84 至 7.31%),P = 0.012)。在无复发生存率的多变量模型中,中心淋巴结侵犯被认为是年轻患者的不良预后因素(HR 5.21(95% 置信区间:1.76 至 15.39)),但不是老年患者的不良预后因素(HR 1.73(95% 置信区间:0.80 至 3.76)):结论:III期结肠癌的年轻患者出现中央淋巴结侵犯的风险较高,这表明疾病的生物学特性更具侵袭性。出现中央淋巴结侵犯与年轻患者的预后较差有关。
{"title":"Lymphatic spread patterns in young versus elderly patients with stage III colon cancer.","authors":"Jihyung Song, Kozo Kataoka, Manabu Inoue, Takeshi Yamada, Manabu Shiozawa, Naohito Beppu, Sho Kuriyama, Takeshi Suto, Nobuhisa Matsuhashi, Yusuke Sakura, Akiyoshi Kanazawa, Hiroyasu Kagawa, Yukihide Kanemitsu, Wim Ceelen, Masataka Ikeda","doi":"10.1093/bjsopen/zrae036","DOIUrl":"10.1093/bjsopen/zrae036","url":null,"abstract":"<p><strong>Background: </strong>The anatomical pattern of lymph nodes spread differs between young (aged 45 years or younger) and elderly (aged 80 years or older) patients with stage III colon cancer and is poorly investigated.</p><p><strong>Methods: </strong>Two groups of patients (young and elderly) with stage III colon cancer who underwent upfront extensive (D3) lymphadenectomy at eight Japanese centres between 1998 and 2018 were retrospectively analysed. The primary endpoint was the proportion of positive central lymph nodes. The lymph nodes spreading pattern and its prognostic impact on recurrence-free survival and overall survival in the two groups were also compared.</p><p><strong>Results: </strong>Two hundred and ten young patients and 348 elderly patients were identified and compared. The total number of lymph nodes harvested and the total number of invaded lymph nodes were significantly higher in younger patients compared with elderly patients (median of 31.5 (3-151) versus 21 (3-116), P < 0.001 and median of 3 (1-21) versus 2 (1-25), P < 0.001 respectively). The proportion of positive central lymph nodes were higher in younger patients than in elderly patients (9.52% (95% c.i. 6.24 to 14.2%) versus 4.59% (95% c.i. 2.84 to 7.31%), P = 0.012). In multivariate models for recurrence-free survival, central lymph nodes invasion were identified as a poor prognostic factor in younger patients (HR 5.21 (95% c.i. 1.76 to 15.39)) but not in elderly patients (HR 1.73 (95% c.i. 0.80 to 3.76)).</p><p><strong>Conclusion: </strong>Young patients with stage III colon cancer have a higher risk of central lymph nodes invasion, suggesting a more aggressive disease biology. The presence of central lymph nodes invasion are associated with a worse outcome in young patients.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11140818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178911","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
Right tool for the right job in the right way: robotic, transanal, or laparoscopic approach for rectal cancer. 用正确的工具、正确的方法完成正确的任务:机器人、经肛门或腹腔镜方法治疗直肠癌。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae069
Deborah S Keller
{"title":"Right tool for the right job in the right way: robotic, transanal, or laparoscopic approach for rectal cancer.","authors":"Deborah S Keller","doi":"10.1093/bjsopen/zrae069","DOIUrl":"10.1093/bjsopen/zrae069","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11170498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141309969","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
Major surgical conditions of childhood and their lifelong implications: comprehensive review. 儿童主要外科疾病及其终身影响:全面回顾。
IF 3.5 3区 医学 Q1 SURGERY Pub Date : 2024-05-08 DOI: 10.1093/bjsopen/zrae028
Paul S Cullis, Dina Fouad, Allan M Goldstein, Kenneth K Y Wong, Ampaipan Boonthai, Pablo Lobos, Mikko P Pakarinen, Paul D Losty

Background: In recent decades, the survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these 'grown-ups' in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood.

Methods: A comprehensive literature review was performed to identify relevant publications. Research studies, review articles and guidelines were sought, focusing on the paediatric management and long-term outcomes of surgical conditions of childhood. The article has been written for adult surgeon readership.

Results: This article describes the aforementioned conditions, their management in childhood and their lifelong implications, including: oesophageal atresia, tracheo-oesophageal fistula, malrotation, short bowel syndrome, duodenal atresia, gastroschisis, exomphalos, choledochal malformations, biliary atresia, Hirschsprung disease, anorectal malformations, congenital diaphragmatic hernia, congenital lung lesions and paediatric cancer.

Conclusion: The increasing survivorship of children affected by surgical conditions will translate into a growing population of adults with lifelong conditions and specialist healthcare needs. The importance of transition from childhood to adulthood is becoming realized. It is hoped that this timely review will enthuse the readership to offer care for such vulnerable patients, and to collaborate with paediatric surgeons in providing successful and seamless transitional care.

背景:近几十年来,先天性畸形和小儿癌症患儿的存活率有了显著提高,因此人们开始逐渐了解这些患儿的终生健康状况。儿科外科医生会在儿童和青少年时期积极处理这些疾病,但成年外科医生必须在成年后照顾这些 "大人"。本文旨在强调小儿外科医生遇到的一些需要长期随访的罕见疾病、这些疾病在儿童期的管理及其对存活的影响,以便成人专科医生更好地掌握管理这些成年患者的技能和知识:方法:进行了全面的文献综述,以确定相关出版物。方法: 我们对文献进行了全面的梳理,找出了相关的出版物,其中包括研究报告、综述文章和指南,重点关注儿童外科疾病的儿科管理和长期疗效。文章是为成年外科医生读者撰写的:本文介绍了上述疾病、其在儿童时期的治疗方法及其对儿童的终生影响,包括:食道闭锁、气管食道瘘、肠旋转不良、短肠综合征、十二指肠闭锁、胃裂、外翻、胆道畸形、胆道闭锁、赫氏肛门病、肛门直肠畸形、先天性膈疝、先天性肺部病变和小儿癌症:受外科疾病影响的儿童存活率越来越高,这将导致越来越多的成年人终生患病,并需要专科医疗服务。人们逐渐意识到从童年向成年过渡的重要性。希望这篇及时的综述能激励读者为这类易受伤害的患者提供护理,并与儿科外科医生合作,提供成功、无缝的过渡护理。
{"title":"Major surgical conditions of childhood and their lifelong implications: comprehensive review.","authors":"Paul S Cullis, Dina Fouad, Allan M Goldstein, Kenneth K Y Wong, Ampaipan Boonthai, Pablo Lobos, Mikko P Pakarinen, Paul D Losty","doi":"10.1093/bjsopen/zrae028","DOIUrl":"10.1093/bjsopen/zrae028","url":null,"abstract":"<p><strong>Background: </strong>In recent decades, the survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these 'grown-ups' in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood.</p><p><strong>Methods: </strong>A comprehensive literature review was performed to identify relevant publications. Research studies, review articles and guidelines were sought, focusing on the paediatric management and long-term outcomes of surgical conditions of childhood. The article has been written for adult surgeon readership.</p><p><strong>Results: </strong>This article describes the aforementioned conditions, their management in childhood and their lifelong implications, including: oesophageal atresia, tracheo-oesophageal fistula, malrotation, short bowel syndrome, duodenal atresia, gastroschisis, exomphalos, choledochal malformations, biliary atresia, Hirschsprung disease, anorectal malformations, congenital diaphragmatic hernia, congenital lung lesions and paediatric cancer.</p><p><strong>Conclusion: </strong>The increasing survivorship of children affected by surgical conditions will translate into a growing population of adults with lifelong conditions and specialist healthcare needs. The importance of transition from childhood to adulthood is becoming realized. It is hoped that this timely review will enthuse the readership to offer care for such vulnerable patients, and to collaborate with paediatric surgeons in providing successful and seamless transitional care.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11110943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080235","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
Economic cost-utility analysis of stage-directed oesophageal cancer treatment. 食道癌分期治疗的经济成本效用分析。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 DOI: 10.1093/bjsopen/zrad159
Geraint L Herbert, David B T Robinson, Arfon G Powell, Tarig Abdelrahman, Usman Khalid, Wyn G Lewis
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引用次数: 0
Daily handover in surgery: systematic review and a novel taxonomy of interventions and outcomes. 外科手术中的日常交接:系统性回顾以及干预措施和结果的新分类法。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 DOI: 10.1093/bjsopen/zrae011
Jessica M Ryan, Fiachra McHugh, Anastasija Simiceva, Walter Eppich, Dara O Kavanagh, Deborah A McNamara

Background: Poor-quality handovers lead to adverse outcomes for patients; however, there is a lack of evidence to support safe surgical handovers. This systematic review aims to summarize the interventions available to improve end-of-shift surgical handover. A novel taxonomy of interventions and outcomes and a modified quality assessment tool are also described.

Methods: Ovid MEDLINE®, PubMed, Embase, and Cochrane databases were searched for articles up to April 2023. Comparative studies describing interventions for daily in-hospital surgical handovers between doctors were included. Studies were grouped according to their interventions and outcomes.

Results: In total, 6139 citations were retrieved, and 41 studies met the inclusion criteria. The total patient sample sizes in the control and intervention groups were 11 946 and 11 563 patients, respectively. Most studies were pre-/post-intervention cohort studies (92.7%), and most (73.2%) represented level V evidence. The mean quality assessment score was 53.4% (17.1). A taxonomy of handover interventions and outcomes was developed, with interventions including handover tools, process standardization measures, staff education, and the use of mnemonics. More than 25% of studies used a document as the only intervention. Overall, 55 discrete outcomes were assessed in four categories including process (n = 27), staff (n = 14), patient (n = 12) and system-level (n = 2) outcomes. Significant improvements were seen in 51.8%, 78.5%, 58.3% (n = 9761 versus 9312 patients) and 100% of these outcomes, respectively.

Conclusions: Most publications demonstrate that good-quality surgical handover improves outcomes and many interventions appear to be effective; however, studies are methodologically heterogeneous. These novel taxonomies and quality assessment tool will help standardize future studies.

背景:质量差的交接班会给患者带来不良后果;然而,目前缺乏支持安全外科交接班的证据。本系统性综述旨在总结可用于改善轮班结束时手术交接的干预措施。此外,还介绍了一种新的干预措施和结果分类法以及一种经过修改的质量评估工具:方法:检索了 Ovid MEDLINE®、PubMed、Embase 和 Cochrane 数据库中截至 2023 年 4 月的文章。纳入了描述医生之间日常院内手术交接干预措施的比较研究。根据干预措施和结果对研究进行分组:共检索到 6139 条引文,41 项研究符合纳入标准。对照组和干预组的患者样本量分别为 11 946 人和 11 563 人。大多数研究为干预前/后队列研究(92.7%),大多数(73.2%)为 V 级证据。平均质量评估得分率为 53.4% (17.1)。对交接班干预措施和结果进行了分类,干预措施包括交接班工具、流程标准化措施、员工教育和使用记忆法。超过 25% 的研究将文件作为唯一的干预措施。总体而言,共评估了 55 项离散结果,分为四类,包括流程(27 项)、员工(14 项)、患者(12 项)和系统级(2 项)结果。在这些结果中,分别有51.8%、78.5%、58.3%(9761对9312名患者)和100%的结果得到显著改善:大多数出版物表明,高质量的手术交接可改善预后,而且许多干预措施似乎是有效的;但是,这些研究在方法上存在差异。这些新的分类标准和质量评估工具将有助于规范未来的研究。
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引用次数: 0
Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis. 食道癌根治性治疗后在肿瘤学结果、手术并发症和健康相关生活质量方面的性别差异:多中心回顾性分析。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2024-03-01 DOI: 10.1093/bjsopen/zrae026
Styliani Mantziari, Jessie A Elliott, Sheraz R Markar, Fredrik Klevebro, Lucas Goense, Asif Johar, Pernilla Lagergren, Giovanni Zaninotto, Richard van Hillegersberg, Mark I van Berge Henegouwen, Markus Schäfer, Magnus Nilsson, George B Hanna, John V Reynolds

Background: Oesophageal cancer, in particular adenocarcinoma, has a strong male predominance. However, the impact of patient sex on operative and oncologic outcomes and recovery of health-related quality of life is poorly documented, and was the focus of this large multicentre cohort study.

Methods: All consecutive patients who underwent oncological oesophagectomy from 2009 to 2015 in the 20 European iNvestigation of SUrveillance after Resection for Esophageal cancer study group centres were assessed. Clinicopathologic variables, therapeutic approach, postoperative complications, survival and health-related quality of life data were compared between male and female patients. Multivariable analyses adjusted for age, sex, tumour histology, treatment protocol and major complications. Specific subgroup analyses comparing adenocarcinoma versus squamous cell cancer for all key outcomes were performed.

Results: Overall, 3974 patients were analysed, 3083 (77.6%) male and 891 (22.4%) female; adenocarcinoma was predominant in both groups, while squamous cell cancer was observed more commonly in female patients (39.8% versus 15.1%, P < 0.001). Multivariable analysis demonstrated improved outcomes in female patients for overall survival (HRmales 1.24, 95% c.i. 1.07 to 1.44) and disease-free survival (HRmales 1.22, 95% c.i. 1.05 to 1.43), which was caused by the adenocarcinoma subgroup, whereas this difference was not confirmed in squamous cell cancer. Male patients presented higher health-related quality of life functional scores but also a higher risk of financial problems, while female patients had lower overall summary scores and more persistent gastrointestinal symptoms.

Conclusion: This study reveals uniquely that female sex is associated with more favourable long-term survival after curative treatment for oesophageal cancer, especially adenocarcinoma, although long-term overall and gastrointestinal health-related quality of life are poorer in women.

背景:食道癌,尤其是腺癌,男性患者居多。然而,患者性别对手术和肿瘤治疗效果以及健康相关生活质量恢复的影响却鲜有记载,这也是这项大型多中心队列研究的重点:方法:对2009年至2015年期间在欧洲20个食管癌切除术后监测调查研究小组中心接受食管癌切除术的所有连续患者进行评估。对男性和女性患者的临床病理变量、治疗方法、术后并发症、存活率以及与健康相关的生活质量数据进行了比较。多变量分析对年龄、性别、肿瘤组织学、治疗方案和主要并发症进行了调整。对腺癌与鳞癌的所有主要结果进行了特定的亚组分析:共分析了 3974 例患者,其中男性 3083 例(77.6%),女性 891 例(22.4%);两组患者均以腺癌为主,而鳞癌在女性患者中更为常见(39.8% 对 15.1%,P < 0.001)。多变量分析显示,女性患者的总生存期(HRmales 1.24,95% c.i.1.07-1.44)和无病生存期(HRmales 1.22,95% c.i.1.05-1.43)均有所改善,这是腺癌亚组造成的,而鳞癌亚组的这一差异未得到证实。男性患者的健康相关生活质量功能评分较高,但出现经济问题的风险也较高,而女性患者的总体综合评分较低,且胃肠道症状更顽固:这项研究独特地揭示了女性性别与食道癌(尤其是腺癌)治愈性治疗后更有利的长期生存有关,尽管女性的长期总体生活质量和胃肠道健康相关生活质量更差。
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