Colonoscopy surveillance after colorectal cancer surgery: meta-analysis
➡️doi.org/10.1093/bjsope…
Colonoscopy surveillance is recommended after colorectal cancer surgery, although the supporting evidence has substantial quality limitations. This systematic review and five randomized clinical trials with 2337 patients; four enrolled patients between 1983 and 1994, and all used additional surveillance modalities. Follow-up protocols with colonoscopy were associated with higher detection of asymptomatic recurrence (RR 2.38) and more curative-intent reoperations (RR 1.66), without a corresponding difference in survival (HR 0.92, 95% c.i. 0.77 to 1.11). Contemporary randomized trials are required to define the independent contribution of colonoscopy.
👏👏👏Joni Panula, Kalle E Hokkanen, @Adductor
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #colorectalcancer #SystematicReview #MetaAnalysis #EvidenceBasedSurgery
➡️doi.org/10.1093/bjsope…
Colonoscopy surveillance is recommended after colorectal cancer surgery, although the supporting evidence has substantial quality limitations. This systematic review and five randomized clinical trials with 2337 patients; four enrolled patients between 1983 and 1994, and all used additional surveillance modalities. Follow-up protocols with colonoscopy were associated with higher detection of asymptomatic recurrence (RR 2.38) and more curative-intent reoperations (RR 1.66), without a corresponding difference in survival (HR 0.92, 95% c.i. 0.77 to 1.11). Contemporary randomized trials are required to define the independent contribution of colonoscopy.
👏👏👏Joni Panula, Kalle E Hokkanen, @Adductor
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #colorectalcancer #SystematicReview #MetaAnalysis #EvidenceBasedSurgery
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640
Staging laparoscopy for radiographically non-metastatic pancreatic ductal adenocarcinoma: cytology-driven upstaging and the SENDAI-SL risk-enrichment score
➡️doi.org/10.1093/bjsope…
Cross-sectional imaging may miss occult metastases and cannot detect positive peritoneal lavage ductal adenocarcinoma. This retrospective single-centre study analyses 504 consecutive patients with radiographically non-metastatic disease who underwent staging laparoscopy between 2013 and 2025. Staging laparoscopy was positive in 141 patients (28.0%), most often through cytology alone (63.8% of positive procedures). Tumour location, tumour size, CA19-9 level and unresectable locally advanced status were associated with positivity and informed the SENDAI-SL score (AUC 0.732). The score may assist prioritisation where resources are limited, pending external validation.
👏👏👏Daisuke Douchi, Shingo Yoshimachi, Naoki Rikiyama, Mika Ando, Yuichiro Umino, Hideaki Sato, Mitsuhiro Shimura, Koetsu Inoue, Masahiro Iseki, Shuichi Aoki, Takayuki Miura, Shimpei Maeda, Masaharu Ishida, Masamichi Mizuma, Atsushi Masamune, Michiaki Unno
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #Laparoscopy
➡️doi.org/10.1093/bjsope…
Cross-sectional imaging may miss occult metastases and cannot detect positive peritoneal lavage ductal adenocarcinoma. This retrospective single-centre study analyses 504 consecutive patients with radiographically non-metastatic disease who underwent staging laparoscopy between 2013 and 2025. Staging laparoscopy was positive in 141 patients (28.0%), most often through cytology alone (63.8% of positive procedures). Tumour location, tumour size, CA19-9 level and unresectable locally advanced status were associated with positivity and informed the SENDAI-SL score (AUC 0.732). The score may assist prioritisation where resources are limited, pending external validation.
👏👏👏Daisuke Douchi, Shingo Yoshimachi, Naoki Rikiyama, Mika Ando, Yuichiro Umino, Hideaki Sato, Mitsuhiro Shimura, Koetsu Inoue, Masahiro Iseki, Shuichi Aoki, Takayuki Miura, Shimpei Maeda, Masaharu Ishida, Masamichi Mizuma, Atsushi Masamune, Michiaki Unno
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #Laparoscopy
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Long-term outcomes after total colonic aganglionosis: retrospective European multicentre cohort study
➡️doi.org/10.1093/bjsope…
Total colonic aganglionosis is a severe form of Hirschsprung disease for which management varies and long-term outcome data are limited. This re study examines 401 patients under follow-up at 31 centres in 15 European countries, with a median age of 7.9 years. At last follow-up, 25% received parenteral nutrition, which was associated with small-bowel aganglionosis exceeding 50 cm (72% versus 15%). Pull-through was performed in 77% of patients; recurrent enterocolitis (36%) and faecal incontinence (25%) were reported, and ten-year mortality was 3.4%. The findings indicate substantial long-term morbidity irrespective of surgical technique.
👏👏👏Annika Mutanen, Alessio Pini Prato, Marta Erculiani, Cécile Lambe, Judith Lindert, Stefanie Märzheuser, Fabio Fusaro, Kjetil Juul Stensrud, Kristin Bjornland, Niels Qvist, Mark Bremholm Ellebæk, Merit M Tabbers, Joep P M Derikx, Rony Sfeir, Konrad Reinshagen, Johanna Ludwiczek, Lucie Poš, Tereza Bartošová, Marc Miserez, Anna Löf Granström, Tomas Wester, Johannes Hilberath, Arnaud Bonnard, Donatella Di Fabrizio, Anat Guz-Mark, Pierre Poinsot, Katrien Van Renterghem, Francesca Destro, Pernilla Stenström, Florian Friedmacher, Udo Rolle, Riccardo Coletta, Antonino Morabito, Francesco Fascetti Leon, Miriam Duci, Cornelius E J Sloots, Hendt Versteegh, Domingas Atouguia, Miguel Campos, Inna Spector Cohen, Stanko Cavar, Ivana Sabolic, Xavier Tarrado, Sophie Langer, Lorenzo Norsa, Mikko P Pakarinen
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #some4peds #pediatricsurgery #GISurg
➡️doi.org/10.1093/bjsope…
Total colonic aganglionosis is a severe form of Hirschsprung disease for which management varies and long-term outcome data are limited. This re study examines 401 patients under follow-up at 31 centres in 15 European countries, with a median age of 7.9 years. At last follow-up, 25% received parenteral nutrition, which was associated with small-bowel aganglionosis exceeding 50 cm (72% versus 15%). Pull-through was performed in 77% of patients; recurrent enterocolitis (36%) and faecal incontinence (25%) were reported, and ten-year mortality was 3.4%. The findings indicate substantial long-term morbidity irrespective of surgical technique.
👏👏👏Annika Mutanen, Alessio Pini Prato, Marta Erculiani, Cécile Lambe, Judith Lindert, Stefanie Märzheuser, Fabio Fusaro, Kjetil Juul Stensrud, Kristin Bjornland, Niels Qvist, Mark Bremholm Ellebæk, Merit M Tabbers, Joep P M Derikx, Rony Sfeir, Konrad Reinshagen, Johanna Ludwiczek, Lucie Poš, Tereza Bartošová, Marc Miserez, Anna Löf Granström, Tomas Wester, Johannes Hilberath, Arnaud Bonnard, Donatella Di Fabrizio, Anat Guz-Mark, Pierre Poinsot, Katrien Van Renterghem, Francesca Destro, Pernilla Stenström, Florian Friedmacher, Udo Rolle, Riccardo Coletta, Antonino Morabito, Francesco Fascetti Leon, Miriam Duci, Cornelius E J Sloots, Hendt Versteegh, Domingas Atouguia, Miguel Campos, Inna Spector Cohen, Stanko Cavar, Ivana Sabolic, Xavier Tarrado, Sophie Langer, Lorenzo Norsa, Mikko P Pakarinen
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #some4peds #pediatricsurgery #GISurg
0
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391
Predictability of symptom changes following hemithyroidectomy due to compression symptoms assessed by specific questionnaires: prospective multicentre study
➡️doi.org/10.1093/bjsope…
Hemithyroidectomy is performed for compression symptoms associated with goitre, although the f remains uncertain at the time of counselling. This prospective multicentre study included 117 patients who completed four validated questionnaires on compressive symptoms before hemithyroidectomy, with repeat assessment at 6 weeks and 1 year. Preoperative symptom severity was not significantly correlated with estimated lobe size, and lobe volume was not significantly associated with symptom change. Most patients reported symptom improvement, and 89% would recommend the procedure at 1 year. Preoperative volume measurements may therefore be of limited value in predicting symptom outcomes.
👏👏👏Ervin Beka, Ivan Shabo, David Fornander, Kenth Johansson, Oliver Gimm
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #endocrinesurgery #thyroid #SoMe4Surgery #SEndocrine
➡️doi.org/10.1093/bjsope…
Hemithyroidectomy is performed for compression symptoms associated with goitre, although the f remains uncertain at the time of counselling. This prospective multicentre study included 117 patients who completed four validated questionnaires on compressive symptoms before hemithyroidectomy, with repeat assessment at 6 weeks and 1 year. Preoperative symptom severity was not significantly correlated with estimated lobe size, and lobe volume was not significantly associated with symptom change. Most patients reported symptom improvement, and 89% would recommend the procedure at 1 year. Preoperative volume measurements may therefore be of limited value in predicting symptom outcomes.
👏👏👏Ervin Beka, Ivan Shabo, David Fornander, Kenth Johansson, Oliver Gimm
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #endocrinesurgery #thyroid #SoMe4Surgery #SEndocrine
0
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666
BJS Open retweeted
What to do with carcinoid crisis in NET surgery?
🆕 Consensus guidance out @BJSOpen
44 experts 🌏18 countries
❌ No routine octreotide prophylaxis
⬆️ Vasopressors as 1st line
🔑 Preop: screen for carcinoid syndrome & heart
doi.org/10.1093/bjsope…
@spartelli @DrFadiTO
🆕 Consensus guidance out @BJSOpen
44 experts 🌏18 countries
❌ No routine octreotide prophylaxis
⬆️ Vasopressors as 1st line
🔑 Preop: screen for carcinoid syndrome & heart
doi.org/10.1093/bjsope…
@spartelli @DrFadiTO
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Novel algorithm for the diagnosis and treatment of different types of bile leakage following liver surgery
➡️doi.org/10.1093/bjsope…
Bile leakage after liver resection with bilioenteric anastomosis may originate from the anastomosis or from the transection surface, and is lacking. In this retrospective study (2008–2023), 229 of 2936 liver resections included a bilioenteric anastomosis, and 96 patients developed posthepatectomy bile leakage: 44 anastomotic leaks (AL), 47 surface leaks and five isolated bile duct leaks (IBDL). Drain bilirubin above 20.85 mg/dl, a drain-to-serum ratio above 10.57 and bilirubin loss above 160.93 mg/day identified AL. Reoperation succeeded in 78% of AL and all IBDL, whereas surface leaks were more often managed non-operatively, supporting a type- and timing-based management algorithm.
👏👏👏Sepehr Abbasi Dezfouli, Elmira Heidenreich, Mohammadamin Shahrbaf, Elias Khajeh, Ali Ramouz, Miriam Klauss, Katharina Hellbach, Osman Öcal, Martin Loos, Arianeb Mehrabi
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSurgery @BJSAcademy #HPBSurgery #LiverSurgery #some4hpb
➡️doi.org/10.1093/bjsope…
Bile leakage after liver resection with bilioenteric anastomosis may originate from the anastomosis or from the transection surface, and is lacking. In this retrospective study (2008–2023), 229 of 2936 liver resections included a bilioenteric anastomosis, and 96 patients developed posthepatectomy bile leakage: 44 anastomotic leaks (AL), 47 surface leaks and five isolated bile duct leaks (IBDL). Drain bilirubin above 20.85 mg/dl, a drain-to-serum ratio above 10.57 and bilirubin loss above 160.93 mg/day identified AL. Reoperation succeeded in 78% of AL and all IBDL, whereas surface leaks were more often managed non-operatively, supporting a type- and timing-based management algorithm.
👏👏👏Sepehr Abbasi Dezfouli, Elmira Heidenreich, Mohammadamin Shahrbaf, Elias Khajeh, Ali Ramouz, Miriam Klauss, Katharina Hellbach, Osman Öcal, Martin Loos, Arianeb Mehrabi
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSurgery @BJSAcademy #HPBSurgery #LiverSurgery #some4hpb
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952
Robotic versus open pancreatoduodenectomy in patients with obesity: propensity score-matched multicentre study
➡️doi.org/10.1093/bjsope…
Obesity is associated with increased morbidity after major abdominal surgery, and evidence on robotic pancreatoduodenectomy (RPD) in this This retrospective multicentre cohort study included patients with BMI ≥30 kg/m²; after propensity score matching, 166 RPD were compared with 166 open pancreatoduodenectomies (OPD). RPD was associated with fewer severe complications (15.7 versus 27.7%), clinically relevant pancreatic fistulas (8.4 versus 18%) and wound infections (4.2 versus 21%), and with shorter hospital stay (11 versus 17 days), without differences in 90-day mortality or R0 resection. RPD may represent an alternative to OPD in patients with obesity at experienced centres.
👏👏👏Valentina Valle, Tiziana Marchese, Benedetto Ielpo, Annalisa Comandatore, Marcello Spampinato, Leonardo Borgioli, Gregorio Di Franco, Pier Cristoforo Giulianotti, Luca Morelli on behalf of the PANFRAIL Collaborative Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #Robotics #MinimallyInvasive
➡️doi.org/10.1093/bjsope…
Obesity is associated with increased morbidity after major abdominal surgery, and evidence on robotic pancreatoduodenectomy (RPD) in this This retrospective multicentre cohort study included patients with BMI ≥30 kg/m²; after propensity score matching, 166 RPD were compared with 166 open pancreatoduodenectomies (OPD). RPD was associated with fewer severe complications (15.7 versus 27.7%), clinically relevant pancreatic fistulas (8.4 versus 18%) and wound infections (4.2 versus 21%), and with shorter hospital stay (11 versus 17 days), without differences in 90-day mortality or R0 resection. RPD may represent an alternative to OPD in patients with obesity at experienced centres.
👏👏👏Valentina Valle, Tiziana Marchese, Benedetto Ielpo, Annalisa Comandatore, Marcello Spampinato, Leonardo Borgioli, Gregorio Di Franco, Pier Cristoforo Giulianotti, Luca Morelli on behalf of the PANFRAIL Collaborative Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #Robotics #MinimallyInvasive
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809
International expert consensus on perioperative management of carcinoid crisis
➡️doi.org/10.1093/bjsope…
Carcinoid crisis remains a serious perioperative risk for patients with neuroendocrine tumours undergoing invasive procedures, and standardized guidance has been lacking. This international consensus, addressing midgut and bronchopulmonary neuroendocrine tumours in non-cardiac surgery, used a modified Delphi process with four voting rounds among a 44-member expert panel including three patient partners. Consensus was reached on 41 statements covering preoperative work-up and optimization (12), intraoperative management (27) and postoperative management (2). Somatostatin analogues are not considered necessary for prophylaxis before or on the day of surgery, and crisis treatment should begin with vasopressors, with short-acting somatostatin analogues as an adjunct.
👏👏👏@HalletJulie, @DrFadiTO, @spartelli, Jonathan Koea, @FlavioRochaMD, Stephanie Ladowski, Jaydira Del Rivero, Chadi Saliba, Jessica Armah, Rodney Pommier, the Carcinoid Crisis Consensus Collaborators
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #SurgicalOncology #CancerSurgery #Oncology
➡️doi.org/10.1093/bjsope…
Carcinoid crisis remains a serious perioperative risk for patients with neuroendocrine tumours undergoing invasive procedures, and standardized guidance has been lacking. This international consensus, addressing midgut and bronchopulmonary neuroendocrine tumours in non-cardiac surgery, used a modified Delphi process with four voting rounds among a 44-member expert panel including three patient partners. Consensus was reached on 41 statements covering preoperative work-up and optimization (12), intraoperative management (27) and postoperative management (2). Somatostatin analogues are not considered necessary for prophylaxis before or on the day of surgery, and crisis treatment should begin with vasopressors, with short-acting somatostatin analogues as an adjunct.
👏👏👏@HalletJulie, @DrFadiTO, @spartelli, Jonathan Koea, @FlavioRochaMD, Stephanie Ladowski, Jaydira Del Rivero, Chadi Saliba, Jessica Armah, Rodney Pommier, the Carcinoid Crisis Consensus Collaborators
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #SurgicalOncology #CancerSurgery #Oncology
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705
Short-term outcomes after major lower limb amputation: meta-analysis
➡️doi.org/10.1093/bjsope…
Decision-making regarding major lower limb amputation depends in part on expected short-term mortality. This systematic review and meta-analysis synthesized population-level studies published between 2008 and 2025 reporting in-hospital or 30-day mortality after amputation at or above the ankle. Fifty-two studies including 1 067 616 patients were analysed, only three of which originated from low- and middle-income countries. Pooled in-hospital mortality was 10.0% (95% CI 8.2 to 12.1%) and 30-day mortality 9.4% (95% CI 8.0 to 11.0%), with prediction intervals of 3.6 to 24.5% and 4.0 to 20.4% respectively. Heterogeneity was high, and prediction intervals may support shared decision-making.
👏👏👏Nick Moody, Rhiannon Nielsen, Megan Lyons, Leanne Murphy, Becky Sandford, David C Bosanquet, Kathryn Chu, Matthew Popplewell, Justine Davies
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #vascularsurgery #SystematicReview #MetaAnalysis #globalsurgery
➡️doi.org/10.1093/bjsope…
Decision-making regarding major lower limb amputation depends in part on expected short-term mortality. This systematic review and meta-analysis synthesized population-level studies published between 2008 and 2025 reporting in-hospital or 30-day mortality after amputation at or above the ankle. Fifty-two studies including 1 067 616 patients were analysed, only three of which originated from low- and middle-income countries. Pooled in-hospital mortality was 10.0% (95% CI 8.2 to 12.1%) and 30-day mortality 9.4% (95% CI 8.0 to 11.0%), with prediction intervals of 3.6 to 24.5% and 4.0 to 20.4% respectively. Heterogeneity was high, and prediction intervals may support shared decision-making.
👏👏👏Nick Moody, Rhiannon Nielsen, Megan Lyons, Leanne Murphy, Becky Sandford, David C Bosanquet, Kathryn Chu, Matthew Popplewell, Justine Davies
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #vascularsurgery #SystematicReview #MetaAnalysis #globalsurgery
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578
Measures of physical fitness and postoperative mortality in patients with colorectal cancer: national cohort study
➡️doi.org/10.1093/bjsope…
Measures of physical fitness are required to adjust for case mix when comparing surgical outcomes. This national cohort study compared the sthesiologists (ASA) grade, Eastern Cooperative Oncology Group performance status and the Secondary Care Administrative Records Frailty index for risk-adjusting 90-day postoperative mortality in 91 957 patients undergoing colorectal cancer surgery in England and Wales (2017–2022). Overall 90-day mortality was 2.8%. A model combining ASA grade and performance status performed equivalently to the full model (C-statistic 0.833 versus 0.834). Either measure alone may support risk-adjusted hospital benchmarking when only one is available.
👏👏👏Adil Rashid, Helen A Blake, Leo Watton, @cam_colorectal, Lu Han, Jan van der Meulen, Kate Walker
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer
➡️doi.org/10.1093/bjsope…
Measures of physical fitness are required to adjust for case mix when comparing surgical outcomes. This national cohort study compared the sthesiologists (ASA) grade, Eastern Cooperative Oncology Group performance status and the Secondary Care Administrative Records Frailty index for risk-adjusting 90-day postoperative mortality in 91 957 patients undergoing colorectal cancer surgery in England and Wales (2017–2022). Overall 90-day mortality was 2.8%. A model combining ASA grade and performance status performed equivalently to the full model (C-statistic 0.833 versus 0.834). Either measure alone may support risk-adjusted hospital benchmarking when only one is available.
👏👏👏Adil Rashid, Helen A Blake, Leo Watton, @cam_colorectal, Lu Han, Jan van der Meulen, Kate Walker
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer
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747
Frailty assessment tools for preoperative evaluation of older adults: scoping review
➡️doi.org/10.1093/bjsope…
The optimal approach to preoperative frailty assessment in surgery remains unclear, as the performance of available tools has been insufficiently evaluated. This ng JBI and PRISMA-ScR guidance, searched four databases from 2005 to May 2026 for studies of adults aged 65 years or older undergoing major intracavitary surgery. From 12 272 records, 160 studies evaluating 35 frailty tools were included, with 40% of tools examined in a single study. Predictive validity was most frequently assessed, whereas reliability, clinical impact and pragmatic factors were less explored. Research addressing clinical impact and tool-specific meta-analyses of performance metrics is indicated.
👏👏👏Tyler R Chesney, Camilla L Wong, Andrea C Tricco, Duminda N Wijeysundera, Marisa Louridas, Kesikan Jayaraj, Claire Sethuram, Amanda Mac, Shawn Khan, Victoria B Anthes, Madeline McDonald, Betty Yibrehu, Amanda Poxon, Anas Samman, Valerie Kim, Karim S Ladha, Teruko Kishibe, Samuel Dubé, Martine Puts, Shabbir M H Alibhai, Julian F Daza
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #EvidenceBasedSurgery #GeneralSurgery
➡️doi.org/10.1093/bjsope…
The optimal approach to preoperative frailty assessment in surgery remains unclear, as the performance of available tools has been insufficiently evaluated. This ng JBI and PRISMA-ScR guidance, searched four databases from 2005 to May 2026 for studies of adults aged 65 years or older undergoing major intracavitary surgery. From 12 272 records, 160 studies evaluating 35 frailty tools were included, with 40% of tools examined in a single study. Predictive validity was most frequently assessed, whereas reliability, clinical impact and pragmatic factors were less explored. Research addressing clinical impact and tool-specific meta-analyses of performance metrics is indicated.
👏👏👏Tyler R Chesney, Camilla L Wong, Andrea C Tricco, Duminda N Wijeysundera, Marisa Louridas, Kesikan Jayaraj, Claire Sethuram, Amanda Mac, Shawn Khan, Victoria B Anthes, Madeline McDonald, Betty Yibrehu, Amanda Poxon, Anas Samman, Valerie Kim, Karim S Ladha, Teruko Kishibe, Samuel Dubé, Martine Puts, Shabbir M H Alibhai, Julian F Daza
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #EvidenceBasedSurgery #GeneralSurgery
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9
1,011
Completion, publication, and outcome reporting of registered randomized trials in abdominal surgery: registry-based cohort study
➡️doi.org/10.1093/bjsope…
Trial discontinuation, non-publication and selective outcome reporting may leave the evidence base in abdominal surgery ry-based cohort study followed abdominal surgery randomized trials from registration to publication, using ClinicalTrials.gov, the EU Clinical Trials Register and the International Clinical Trials Registry Platform. Of 295 eligible trials, 160 (54%) were listed as completed, and 119 of these (74%) had a corresponding publication. Completed superiority trials that added or modified primary endpoints were more likely to report P < 0.050 (OR 4.28; 95% CI 2.23 to 8.22). These findings are relevant to guideline development and meta-analysis.
👏👏👏Klaudia Narbekovas, Christoph Kuemmerli, Sandro Huegli, Jasper P Sijberden, Lukas W Widmer, Oliver Strobel, Max F Stauffer, Ethan B Ludmir, Carl-Stephan Leonhardt
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #EvidenceBasedSurgery #GeneralSurgery #RCT
➡️doi.org/10.1093/bjsope…
Trial discontinuation, non-publication and selective outcome reporting may leave the evidence base in abdominal surgery ry-based cohort study followed abdominal surgery randomized trials from registration to publication, using ClinicalTrials.gov, the EU Clinical Trials Register and the International Clinical Trials Registry Platform. Of 295 eligible trials, 160 (54%) were listed as completed, and 119 of these (74%) had a corresponding publication. Completed superiority trials that added or modified primary endpoints were more likely to report P < 0.050 (OR 4.28; 95% CI 2.23 to 8.22). These findings are relevant to guideline development and meta-analysis.
👏👏👏Klaudia Narbekovas, Christoph Kuemmerli, Sandro Huegli, Jasper P Sijberden, Lukas W Widmer, Oliver Strobel, Max F Stauffer, Ethan B Ludmir, Carl-Stephan Leonhardt
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #EvidenceBasedSurgery #GeneralSurgery #RCT
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658
Multimodal prehabilitation in colorectal cancer surgery: randomized clinical trial
➡️doi.org/10.1093/bjsope…
Multidisciplinary prehabilitation has been proposed to reduce postoperative morbidity after colorectal cancer surgery, with effects possibly varying by baseline physical function. This single-centre randomized clinical trial at a Stockholm tertiary hospital allocated patients 1:1 to multidisciplinary prehabilitation or standard enhanced recovery care. Of 328 randomized patients, 242 underwent surgery and were analysed (122 intervention, 120 control). Postoperative complications occurred in 47.5% of the intervention group and 45.0% of the control group, without a significant difference. Lower weight loss and modest improvements in physical performance were observed at 30 days; exploratory analyses indicated a treatment-by-baseline-function interaction for severe complications.
👏👏👏Felix Bjerregaard, Klas Pekkari, Daniel Asklid, Claes Anderin, Karin Westberg, Richard Marsk, Ulf O Gustafsson
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #prehabilitation #RCT
➡️doi.org/10.1093/bjsope…
Multidisciplinary prehabilitation has been proposed to reduce postoperative morbidity after colorectal cancer surgery, with effects possibly varying by baseline physical function. This single-centre randomized clinical trial at a Stockholm tertiary hospital allocated patients 1:1 to multidisciplinary prehabilitation or standard enhanced recovery care. Of 328 randomized patients, 242 underwent surgery and were analysed (122 intervention, 120 control). Postoperative complications occurred in 47.5% of the intervention group and 45.0% of the control group, without a significant difference. Lower weight loss and modest improvements in physical performance were observed at 30 days; exploratory analyses indicated a treatment-by-baseline-function interaction for severe complications.
👏👏👏Felix Bjerregaard, Klas Pekkari, Daniel Asklid, Claes Anderin, Karin Westberg, Richard Marsk, Ulf O Gustafsson
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #prehabilitation #RCT
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940
Multicentre parallel-group open-label non-inferiority randomized clinical trial of recooling versus no recooling after normothermic machine perfusion in liver transplantation: ARANMP-LT protocol
➡️doi.org/10.1093/bjsope…
Liver grafts are frequently recooled before implantation after normothermic machine perfusion, although this step has never been evaluated in a randomized setting and temperature cycling may contribute to graft injury. This protocol describes ARANMP-LT, an investigator-initiated, open-label, parallel-group non-inferiority randomized clinical trial at multiple Italian centres. Adult recipients of machine-perfused deceased-donor livers will be randomized 1:1 to a portal flush with 5% albumin at 20–25°C without cold exposure or a cold preservation solution flush. The primary outcome is freedom from early allograft dysfunction within 7 days, with 170 patients planned.
👏👏👏Salvatore Gruttadauria, Roberta Vella, Fabrizio Di Francesco, Duilio Pagano, Marco Barbara, Monica Rizzo, Ivan Vella, Sergio Calamia, Alessandro Tropea, Pasquale Bonsignore, Caterina Accardo, Gaetano Burgio, Enzo Andorno, Marco Miggino, Stefania Camagni, Domenico Pinelli, Amedeo Carraro, Alex Borin, Matteo Cescon, Matteo Serenari, Umberto Cillo, Jacopo Lanari, Fabrizio Di Benedetto, Paolo Magistri, Giuseppe Maria Ettorre, Sara Ingallinella, Francesco Frongillo, Marco Maria Pascale, Davide Ghinolfi, Giulia Cirillo, Fabio Melandro, Gianluca Mennini, Francesco Tandoi, Irene Scalera, Giuseppe Tisone, Roberta Angelico, Marco Vivarelli, Federico Mocchegiani, Sergio Li Petri
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #protocol #RCT #livertransplant #HPBSurgery
➡️doi.org/10.1093/bjsope…
Liver grafts are frequently recooled before implantation after normothermic machine perfusion, although this step has never been evaluated in a randomized setting and temperature cycling may contribute to graft injury. This protocol describes ARANMP-LT, an investigator-initiated, open-label, parallel-group non-inferiority randomized clinical trial at multiple Italian centres. Adult recipients of machine-perfused deceased-donor livers will be randomized 1:1 to a portal flush with 5% albumin at 20–25°C without cold exposure or a cold preservation solution flush. The primary outcome is freedom from early allograft dysfunction within 7 days, with 170 patients planned.
👏👏👏Salvatore Gruttadauria, Roberta Vella, Fabrizio Di Francesco, Duilio Pagano, Marco Barbara, Monica Rizzo, Ivan Vella, Sergio Calamia, Alessandro Tropea, Pasquale Bonsignore, Caterina Accardo, Gaetano Burgio, Enzo Andorno, Marco Miggino, Stefania Camagni, Domenico Pinelli, Amedeo Carraro, Alex Borin, Matteo Cescon, Matteo Serenari, Umberto Cillo, Jacopo Lanari, Fabrizio Di Benedetto, Paolo Magistri, Giuseppe Maria Ettorre, Sara Ingallinella, Francesco Frongillo, Marco Maria Pascale, Davide Ghinolfi, Giulia Cirillo, Fabio Melandro, Gianluca Mennini, Francesco Tandoi, Irene Scalera, Giuseppe Tisone, Roberta Angelico, Marco Vivarelli, Federico Mocchegiani, Sergio Li Petri
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #protocol #RCT #livertransplant #HPBSurgery
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Chyme reinfusion using The Insides® System to reduce parenteral nutrition dependence in type 2 intestinal failure: multicentre randomized clinical trial (REINFUSE)
➡️doi.org/10.1093/bjsope…
Type 2 intestinal failure due to double enterostomy or enterocutaneous fistula entails l nutrition (PN), and chyme reinfusion therapy (CRT) has not been evaluated in a randomized trial. This trial randomized 39 PN-dependent adults at 12 UK and US centres 2 : 1 to device-assisted CRT plus standard care or standard care alone. At 30 days, 8 of 26 active participants (31%) achieved a ≥ 50% PN calorie reduction versus none of 13 controls (P = 0.035; prespecified threshold P < 0.025). At 60 days, 10 active participants had ceased PN, with an acceptable safety profile.
👏👏👏Tony Milne, Simon Lal, Arun Abraham, Kirstine Farrer, Jonathan Evans, Kathryn Thomas, Carolynne Vaizey, Simon Gabe, David Layfield, Neena Randhawa, John Rogers, David F Mercer, Liran Barda, Robert E Carroll, Martin D Rosenthal, Syed-Mohammed Jafri, Chris Frampton, Dermot Burke
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #RCT #EvidenceBasedSurgery #IntestinalFailure
➡️doi.org/10.1093/bjsope…
Type 2 intestinal failure due to double enterostomy or enterocutaneous fistula entails l nutrition (PN), and chyme reinfusion therapy (CRT) has not been evaluated in a randomized trial. This trial randomized 39 PN-dependent adults at 12 UK and US centres 2 : 1 to device-assisted CRT plus standard care or standard care alone. At 30 days, 8 of 26 active participants (31%) achieved a ≥ 50% PN calorie reduction versus none of 13 controls (P = 0.035; prespecified threshold P < 0.025). At 60 days, 10 active participants had ceased PN, with an acceptable safety profile.
👏👏👏Tony Milne, Simon Lal, Arun Abraham, Kirstine Farrer, Jonathan Evans, Kathryn Thomas, Carolynne Vaizey, Simon Gabe, David Layfield, Neena Randhawa, John Rogers, David F Mercer, Liran Barda, Robert E Carroll, Martin D Rosenthal, Syed-Mohammed Jafri, Chris Frampton, Dermot Burke
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #RCT #EvidenceBasedSurgery #IntestinalFailure
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Survival impact of involvement of lymph node stations 16b1, 9, and 8a during pancreatoduodenectomy for pancreatic and periampullary cancers (PANODE): prospective multicentre study
➡️doi.org/10.1093/bjsope…
Guidelines do not recommend routine sampling of lymph node stations (LNS) pancreatoduodenectomy, as prospective multicentre data have been lacking. This prospective multicentre cohort study included 1218 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma (n = 673), distal cholangiocarcinoma, ampullary cancer, or duodenal cancer between 2015 and 2020. LNS 16b1 involvement was associated with worse overall survival across all four diagnoses, with an adjusted hazard ratio of 2.33 (95% c.i. 1.62 to 3.35) in pancreatic ductal adenocarcinoma. The authors propose that future studies assess routine preoperative and intraoperative LNS 16b1 sampling.
👏👏👏J Annelie Suurmeijer, Bobby K Pranger, Leonard W F Seelen, Mahsoem Ali, L Bengt van Rijssen, Dorine S Tseng, Tara M Mackay, Jacob L van Dam, Hjalmar C van Santvoort, Bas Groot Koerkamp, Arantza Farina Sarasqueta, Casper H van Eijck, Mike S L Liem, Geert Kazemier, Vincent B Nieuwenhuijs, Ignace H de Hingh, Joost M Klaase, Joris I Erdmann, Olivier R Busch, I Quintus Molenaar, Vincent E de Meijer, @MarcBesselink , on behalf of the Dutch Pancreatic Cancer Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #SurgicalOncology
➡️doi.org/10.1093/bjsope…
Guidelines do not recommend routine sampling of lymph node stations (LNS) pancreatoduodenectomy, as prospective multicentre data have been lacking. This prospective multicentre cohort study included 1218 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma (n = 673), distal cholangiocarcinoma, ampullary cancer, or duodenal cancer between 2015 and 2020. LNS 16b1 involvement was associated with worse overall survival across all four diagnoses, with an adjusted hazard ratio of 2.33 (95% c.i. 1.62 to 3.35) in pancreatic ductal adenocarcinoma. The authors propose that future studies assess routine preoperative and intraoperative LNS 16b1 sampling.
👏👏👏J Annelie Suurmeijer, Bobby K Pranger, Leonard W F Seelen, Mahsoem Ali, L Bengt van Rijssen, Dorine S Tseng, Tara M Mackay, Jacob L van Dam, Hjalmar C van Santvoort, Bas Groot Koerkamp, Arantza Farina Sarasqueta, Casper H van Eijck, Mike S L Liem, Geert Kazemier, Vincent B Nieuwenhuijs, Ignace H de Hingh, Joost M Klaase, Joris I Erdmann, Olivier R Busch, I Quintus Molenaar, Vincent E de Meijer, @MarcBesselink , on behalf of the Dutch Pancreatic Cancer Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #SurgicalOncology
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Early inflammatory signal in late-diagnosed anastomotic leakage after anterior resection
➡️doi.org/10.1093/bjsope…
Anastomotic leakage after anterior resection for rectal cancer is frequently diagnosed late, and it has been suggested that such leaks may have been present but s research letter reports a post hoc exploratory analysis of a retrospective multicentre cohort of 1118 patients from 11 Swedish centres, comparing maximum C-reactive protein within 14 days after surgery by timing of leakage. Median maximum values were 108.5 mg/L without leakage, 270 mg/L with early leakage, and 167.5 mg/L with late leakage. Late-diagnosed leaks were associated with an early inflammatory signal.
👏👏👏Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer Parkon behalf of the RectoLeak Study Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer
➡️doi.org/10.1093/bjsope…
Anastomotic leakage after anterior resection for rectal cancer is frequently diagnosed late, and it has been suggested that such leaks may have been present but s research letter reports a post hoc exploratory analysis of a retrospective multicentre cohort of 1118 patients from 11 Swedish centres, comparing maximum C-reactive protein within 14 days after surgery by timing of leakage. Median maximum values were 108.5 mg/L without leakage, 270 mg/L with early leakage, and 167.5 mg/L with late leakage. Late-diagnosed leaks were associated with an early inflammatory signal.
👏👏👏Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer Parkon behalf of the RectoLeak Study Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer
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Rationale and design of the SENTRY trial: sentinel node and organ-preserving surgery versus segmental resection in stage I colon cancer
➡️doi.org/10.1093/bjsope…
Early-stage colon cancer is increasingly managed by local resection, after which histopathological risk factors ntal resection follows, often in patients without lymph node metastases. This research letter describes the rationale and design of SENTRY, a prospective, multicentre, partially randomised patient preference trial in the Netherlands comparing sentinel node and organ-preserving surgery, using indocyanine green and colonoscopy-assisted laparoscopic wedge resection, with segmental resection in stage I colon cancer. The primary outcome is 3-year overall recurrence, with a feasibility phase of 40 patients preceding the main non-inferiority phase.
👏👏👏Bart C T van de Laar, Daan J Sikkenk, Pieter J Tanis, Paul M Verheijen, Matthijs P Schwartz, Halil Akol, René Arensman, Frank J Voskens, Leon M G Moons, Wouter H de Vos tot Nederveen Cappel, Henderik L van Westreenen, Wouter B Nagengast, Esther C J Consten
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer #protocol #MinimallyInvasive
➡️doi.org/10.1093/bjsope…
Early-stage colon cancer is increasingly managed by local resection, after which histopathological risk factors ntal resection follows, often in patients without lymph node metastases. This research letter describes the rationale and design of SENTRY, a prospective, multicentre, partially randomised patient preference trial in the Netherlands comparing sentinel node and organ-preserving surgery, using indocyanine green and colonoscopy-assisted laparoscopic wedge resection, with segmental resection in stage I colon cancer. The primary outcome is 3-year overall recurrence, with a feasibility phase of 40 patients preceding the main non-inferiority phase.
👏👏👏Bart C T van de Laar, Daan J Sikkenk, Pieter J Tanis, Paul M Verheijen, Matthijs P Schwartz, Halil Akol, René Arensman, Frank J Voskens, Leon M G Moons, Wouter H de Vos tot Nederveen Cappel, Henderik L van Westreenen, Wouter B Nagengast, Esther C J Consten
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer #protocol #MinimallyInvasive
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Revisiting lymphatic dissemination in gastric cancer: insights from a large Western multicentre cohort
➡️doi.org/10.1093/bjsope…
This invited commentary discusses a Western multicentre retrospective cohort study of 950 patients from five European centres that examined patterns of lymph node spread in gastric cancer. The commentary considers whether nodal dissemination in Western patients follows the Eastern pattern, in the context of growing interest in less extensive gastrectomy. Diffuse and mixed histological subtypes were associated with nearly twice the incidence of nodal metastasis of intestinal-type tumours, and microsatellite-unstable tumours showed lower nodal involvement. The authors emphasise accurate specimen dissection and suggest that fluorescence-guided surgery may improve nodal assessment.
👏👏👏Marcus Fernando Kodama Pertille Ramos, Rubén Aguilar Zapag, Carlos García Carrasco
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #UpperGISurgery #GastricCancer #GISurg #SurgicalOncology
➡️doi.org/10.1093/bjsope…
This invited commentary discusses a Western multicentre retrospective cohort study of 950 patients from five European centres that examined patterns of lymph node spread in gastric cancer. The commentary considers whether nodal dissemination in Western patients follows the Eastern pattern, in the context of growing interest in less extensive gastrectomy. Diffuse and mixed histological subtypes were associated with nearly twice the incidence of nodal metastasis of intestinal-type tumours, and microsatellite-unstable tumours showed lower nodal involvement. The authors emphasise accurate specimen dissection and suggest that fluorescence-guided surgery may improve nodal assessment.
👏👏👏Marcus Fernando Kodama Pertille Ramos, Rubén Aguilar Zapag, Carlos García Carrasco
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #UpperGISurgery #GastricCancer #GISurg #SurgicalOncology
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