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Background: Primary ventral and incisional hernias are frequent conditions that impact the quality of life of patients. Surgical techniques for ventral hernia repair are constantly evolving and abdominal wall surgery has turned into a highly specialized field.

Methods: This is a narrative review of the most recent and relevant literature on the treatment of primary ventral and incisional hernias performed by eight experts in ventral hernia surgery from across the world and includes review of classification systems, preoperative measures, descriptions of surgical techniques, and postoperative complications.

Results: Repairs of primary ventral and incisional hernias range from simple open procedures in healthy patients with small defects to complex procedures when patients are co-morbid and have large defects. Optimizing patient-related risk factors before surgery is important to decrease complication rates. Surgical repair techniques from open repairs to minimally invasive procedures are described in detail in the review. Minimally invasive techniques are technically more demanding and take longer, but decrease the risk of surgical-site infections and shorten the duration of hospital stay.

Conclusion: Treatment of ventral hernias aims to improve the quality of life of patients. The risks and benefits of procedures should be weighed against patients' complaints and co-morbidities. Optimizing patient-related risk factors before surgery is important.

Background: For the early detection of colorectal cancer, it is important to identify the premalignant lesions to prevent cancer development. Non-invasive testing methods such as the faecal immunochemical test are well established for the screening and triage of patients with suspected colorectal cancer but are not routinely used for polyps. Additionally, the role of volatile organic compounds has been tested for cancer detection. The aim of this review was to determine the diagnostic accuracy of the faecal immunochemical test and volatile organic compounds in detecting colorectal polyps.

Methods: Original articles with diagnostic test accuracy measures for both the faecal immunochemical test and volatile organic compounds for advanced adenomas were included. Four databases including Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Web of Science were searched. The quality assessment tool for diagnostic accuracy study was used to assess the risk of bias and applicability. Meta-analysis was performed using RStudio® and the combined faecal immunochemical test-volatile organic compounds sensitivity and specificity were computed.

Results: Twenty-two faecal immunochemical tests and 12 volatile organic compound-related articles were included in the systematic review whilst 18 faecal immunochemical tests and eight volatile organic compound-related studies qualified for the meta-analysis. The estimated pooled sensitivity and specificity of the faecal immunochemical test to diagnose advanced adenoma(s) were 36% (95% c.i. 30 to 41) and 89% (95% c.i. 86 to 91) respectively, with an area under the curve of 0.65, whilst volatile organic compounds pooled sensitivity and specificity was 83% (95% c.i. 70 to 91) and 76% (95% c.i. 60 to 87) respectively, with an area under the curve of 0.84. The combined faecal immunochemical test-volatile organic compounds increased the sensitivity to 89% with a specificity of 67%.

Conclusion: Faecal immunochemical testing has a higher specificity but poor sensitivity for detecting advanced adenomas, while volatile organic compound analysis is more sensitive. The combination of both tests enhances the detection rate of advanced adenomas.

Background: The most frequently invaded margins on pancreatoduodenectomy specimens for pancreatic ductal adenocarcinoma are vascular margins, particularly the superior mesenteric artery (or mesopancreatic) margin. Due to limited exploration of the radiological aspect of the mesopancreas, the aim of this study was to evaluate mesopancreatic infiltration through imaging of patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy, to correlate these findings with histopathology and evaluate their impact on survival.

Methods: Data for all patients who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma from 2015 to 2021 were reviewed, including review of surgical margin histopathology and blinded review of preoperative diagnostic imaging. According to qualitative radiological assessment, the mesopancreas was characterized as having normal fat, fat stranding, or solid infiltration. Survival data were analysed using Cox regression.

Results: A total of 149 patients were included. At baseline imaging, mesopancreatic fat stranding or solid infiltration was present in 47 patients (31.5%) and 20 patients (13.4%) respectively. Median overall survival and disease-free survival were significantly lower with mesopancreatic solid infiltration (17 and 8 months) compared with normal fat (30 and 14 months) and fat stranding (29 and 16 months) (P = 0.017 and 0.028 respectively). In multivariable analysis, pathological tumour size was an independent prognostic factor for overall survival, and tumour location in the uncinate process and pathological tumour size were independent prognostic factors for disease-free survival.

Conclusion: At diagnostic imaging, solid infiltration (but not fat stranding) of the mesopancreas is associated with a poor prognosis for pancreatic ductal adenocarcinoma patients who undergo pancreatoduodenectomy. Pathological tumour size significantly influences the prediction of overall survival, and tumour location in the uncinate process and pathological tumour size significantly influence the prediction of disease-free survival, suggesting further exploration of underlying mechanisms related to retroperitoneal tumoral invasion of vascular margins and the mesopancreas.

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.

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.

Background: There are differences in oesophageal cancer care across Sweden. According to national guidelines, all patients should be offered equal care, planned and administrated by regional multidisciplinary team meetings. The aim of the study was to investigate differences between regional multidisciplinary team meetings in Sweden regarding clinical staging and treatment recommendations for oesophageal cancer patients.

Methods: All six Swedish regional multidisciplinary teams were each invited to retrospectively include ten consecutive oesophageal cancer cases. After anonymization, radiological investigations were presented, along with the original case-specific medical history, anew at the participating regional multidisciplinary team meetings. Estimation of clinical tumour node metastasis (TNM) classification and treatment recommendation (curative, palliative or best supportive care) were compared between multidisciplinary team meetings as well as with original assessments.

Results: Five multidisciplinary teams participated and contributed a total of 50 cases presented to each multidisciplinary team. In estimations of cT-stage, the multidisciplinary teams were in total agreement in only eight of 50 cases (16%). For cN-stage, total agreement was seen in 17 of 50 cases (34%) and for cM-stage there was agreement in 34 cases (68%). For cT-stage, the overall summarized κ value was 0.57. For N-stage and M-stage the κ values were 0.66 and 0.78 respectively. Differences in appraisal were not associated with usage of positron emission tomography-computed tomography. In 15 of 50 cases (30%) the multidisciplinary teams disagreed on curative or palliative treatment.

Conclusion: The study shows differences in assessment of clinical TNM classification and treatment recommendations made at regional multidisciplinary team meetings. Increased interrater agreement on clinical TNM classification and management plans are essential to achieve more equal care for oesophageal cancer patients in Sweden.

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.

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.

Background: As the survival of preterm infants has increased, the management of long-term complications, especially neurodevelopmental impairment, becomes increasingly important. The aim of this study was to investigate the risk of neurodevelopmental disorders in preterm babies receiving medical or surgical treatment for necrotizing enterocolitis, compared with other preterm babies and preterm babies who received abdominal surgery for other indications.

Methods: In this nationwide Swedish cohort study, including all liveborn preterm babies born between 1998 and 2019, the risk of attention deficit (and hyperactivity) disorder, autism spectrum disorders, cerebral palsy and intellectual disability was assessed by multivariable Cox regression, expressed as hazard ratios and 95% confidence intervals (c.i.).

Results: Of the surgically (n = 384) and medically (n = 709) treated preterm infants with necrotizing enterocolitis, neurodevelopmental disorders were present in 32% (HR 2.24, 95% c.i. 1.86 to 2.69) and 22% respectively (HR 1.40, 95% c.i. 1.19 to 1.65), compared with 21% (HR 1.63, 95% c.i. 1.40 to 1.91) in the abdominal surgery group (n = 844) and 13% (reference) among other preterm infants (n = 78 972). The highest relative increases were for intellectual disability (HR 3.60, 95% c.i. 2.65 to 4.89) in the surgical necrotizing enterocolitis group and abdominal surgery group (HR 2.84, 95% c.i. 2.12 to 3.80) compared with the control preterm group, and for cerebral palsy (respectively HR 2.74, 95% c.i. 2.04 to 3.68 and HR 2.54, 95% c.i. 1.87 to 3.44). Medically treated necrotizing enterocolitis was associated with autism (HR 1.67, 95% c.i. 1.34 to 2.08), without significant increases for the other specific outcomes. Both surgically treated groups were also strongly associated with both attention deficit (and hyperactivity) disorder and autism.

Conclusion: Surgically treated necrotizing enterocolitis, medically treated necrotizing enterocolitis and abdominal surgery for other indications in preterm infants were all associated with an increased risk of impaired neurodevelopmental outcomes, compared with other preterm infants.