{"title":"Immunotherapy in the surgical patient: Perioperative considerations.","authors":"Nicola McShane,Ciaran M Hurley,Roisin T Dolan","doi":"10.1093/bjs/znag096","DOIUrl":"https://doi.org/10.1093/bjs/znag096","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P J Nilsson,I Prata,M D Tanaka,A M Couwenberg,B van Etten,G A P Hospers,B Glimelius,C J H van de Velde
{"title":"Explaining increased locoregional failure following TNT in RAPIDO.","authors":"P J Nilsson,I Prata,M D Tanaka,A M Couwenberg,B van Etten,G A P Hospers,B Glimelius,C J H van de Velde","doi":"10.1093/bjs/znag095","DOIUrl":"https://doi.org/10.1093/bjs/znag095","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"31 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148441246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
José M Balibrea,Javier Osorio,Joaquín Resa,María Álvarez,Mireya Robles-Plaza,Julen Monje,Miguel Ángel Casado,Laura Salinas-Ortega
BACKGROUNDDespite its low incidence, leaks result in high morbidity and represent the second cause of death after metabolic bariatric surgery (MBS). The economic impact of diagnosing and managing early leaks after MBS was assessed within the Spanish Health System.METHODA cost analysis model was developed to estimate the resource consumption of patients with early leaks after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Through a comprehensive literature review, an epidemiological framework was established to estimate the incidence of early leaks. Patients were classified into fourteen scenarios based on the type of MBS performed, initial management of the early leak (conservative, endoscopic and/or surgical), and the need for a secondary treatment. Resource consumption over a one-year time horizon was collected based on clinical practice, and unit costs in year 2025 were obtained from national databases. All parameters were validated by a panel of experts, and sensitivity analyses were conducted to assess the robustness of the results.RESULTSTotal costs of early leaks reached €4,199,549, including €3,469,303 after LSG (82 events/year) and €730,246 after LRYGB (18 events/year). The cost per patient with an early leak after LSG ranged from €13,358 to €94,532, with a weighted average cost of €42,285 and after LRYGB from €13,110 to €94,284, with a weighted average cost of €40,971. Hospital stays and health procedures represented the highest cost. The sensitivity analysis results ranged between €1,189,220- €7,209,878.CONCLUSIONSEarly leak after MBS markedly increased health resource utilization, mainly due to an increase in hospitalizations, with cost increase associated with the complexity of the event.
{"title":"Short-term economic impact of early leaks following metabolic bariatric surgery.","authors":"José M Balibrea,Javier Osorio,Joaquín Resa,María Álvarez,Mireya Robles-Plaza,Julen Monje,Miguel Ángel Casado,Laura Salinas-Ortega","doi":"10.1093/bjs/znag072","DOIUrl":"https://doi.org/10.1093/bjs/znag072","url":null,"abstract":"BACKGROUNDDespite its low incidence, leaks result in high morbidity and represent the second cause of death after metabolic bariatric surgery (MBS). The economic impact of diagnosing and managing early leaks after MBS was assessed within the Spanish Health System.METHODA cost analysis model was developed to estimate the resource consumption of patients with early leaks after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Through a comprehensive literature review, an epidemiological framework was established to estimate the incidence of early leaks. Patients were classified into fourteen scenarios based on the type of MBS performed, initial management of the early leak (conservative, endoscopic and/or surgical), and the need for a secondary treatment. Resource consumption over a one-year time horizon was collected based on clinical practice, and unit costs in year 2025 were obtained from national databases. All parameters were validated by a panel of experts, and sensitivity analyses were conducted to assess the robustness of the results.RESULTSTotal costs of early leaks reached €4,199,549, including €3,469,303 after LSG (82 events/year) and €730,246 after LRYGB (18 events/year). The cost per patient with an early leak after LSG ranged from €13,358 to €94,532, with a weighted average cost of €42,285 and after LRYGB from €13,110 to €94,284, with a weighted average cost of €40,971. Hospital stays and health procedures represented the highest cost. The sensitivity analysis results ranged between €1,189,220- €7,209,878.CONCLUSIONSEarly leak after MBS markedly increased health resource utilization, mainly due to an increase in hospitalizations, with cost increase associated with the complexity of the event.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"445 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caleb Haley,Shane D Morrison,Manraj N Kaur,Charlene Rae,Megan Lane,Danny A Young-Afat,Tim C van de Grift,Nicola R Dean,Kathleen A Armstrong,Devin Coon,Zac A Cannell,Christian X Lava,Sylvie D Cornacchi,Alexis Laungani,Margriet G Mullender,Jens Ahm Sørensen,Lotte Poulsen,Jack G Graesser,Thomas Satterwhite,Allison C Hu,Gerhard S Mundinger,Hilliard T Brydges,Jessica J Hsu,Blair R Peters,Jens U Berli,Christodoulos Kaoutzanis,Nargis Kalia,Rachel Bluebond-Langner,Oren Ganor,Alireza Hamidian Jahromi,Bashar A Hassan,Fan Liang,John H Pang,Edward C Ray,Gabriel A Del Corral,Kenneth L Fan,Lily R Mundy,Andrea L Pusic,Anne F Klassen
INTRODUCTIONMasculinizing gender-affirming chest surgery is the most frequently accessed gender-affirming procedure. The GENDER-Q Chest scales were developed to better assess patient-reported outcomes in masculinizing gender-affirming chest surgery, yet previous psychometric assessment of these scales is limited. The objective of this study was to assess the construct validity of the GENDER-Q Chest scales (Chest, Nipples & Areolas, and Scars).METHODSAn international, cross-sectional study was performed to develop the GENDER-Q between February 2022 and March 2024. Individuals were included in this analysis if they had sought or received masculinizing gender-affirming chest surgery and completed the GENDER-Q Chest scale. Construct validity was assessed for each scale by testing a priori hypotheses. According to Consensus-based Standards for the Selection of Health Measurement Instruments guidelines, greater than 75% acceptance of hypotheses indicates sufficient evidence of construct validity.RESULTSA total of 2,846 participants completed the GENDER-Q Chest scale. For the GENDER-Q Chest, Nipples & Areolas, and Scars scales, 95% (21/22), 79% (15/19), and 100% (12/12) of hypotheses were accepted for each scale, respectively. Patients who underwent surgery and do not currently need revisions reported the highest satisfaction, while patients who had not yet undergone surgery reported the lowest satisfaction.CONCLUSIONThe GENDER-Q Chest scales evidenced construct validity to measure appearance of chest, nipples, and scars for individuals seeking or undergoing masculinizing gender-affirming chest surgery. The GENDER-Q Chest scales provide a robust, validated approach for assessing outcomes in this context and are well-suited for generating high-quality evidence on patient-reported outcomes.
{"title":"Patient-Reported Outcomes in Masculinizing Gender-Affirming Chest Surgery: Validation of the GENDER-Q Chest Scales.","authors":"Caleb Haley,Shane D Morrison,Manraj N Kaur,Charlene Rae,Megan Lane,Danny A Young-Afat,Tim C van de Grift,Nicola R Dean,Kathleen A Armstrong,Devin Coon,Zac A Cannell,Christian X Lava,Sylvie D Cornacchi,Alexis Laungani,Margriet G Mullender,Jens Ahm Sørensen,Lotte Poulsen,Jack G Graesser,Thomas Satterwhite,Allison C Hu,Gerhard S Mundinger,Hilliard T Brydges,Jessica J Hsu,Blair R Peters,Jens U Berli,Christodoulos Kaoutzanis,Nargis Kalia,Rachel Bluebond-Langner,Oren Ganor,Alireza Hamidian Jahromi,Bashar A Hassan,Fan Liang,John H Pang,Edward C Ray,Gabriel A Del Corral,Kenneth L Fan,Lily R Mundy,Andrea L Pusic,Anne F Klassen","doi":"10.1093/bjs/znag089","DOIUrl":"https://doi.org/10.1093/bjs/znag089","url":null,"abstract":"INTRODUCTIONMasculinizing gender-affirming chest surgery is the most frequently accessed gender-affirming procedure. The GENDER-Q Chest scales were developed to better assess patient-reported outcomes in masculinizing gender-affirming chest surgery, yet previous psychometric assessment of these scales is limited. The objective of this study was to assess the construct validity of the GENDER-Q Chest scales (Chest, Nipples & Areolas, and Scars).METHODSAn international, cross-sectional study was performed to develop the GENDER-Q between February 2022 and March 2024. Individuals were included in this analysis if they had sought or received masculinizing gender-affirming chest surgery and completed the GENDER-Q Chest scale. Construct validity was assessed for each scale by testing a priori hypotheses. According to Consensus-based Standards for the Selection of Health Measurement Instruments guidelines, greater than 75% acceptance of hypotheses indicates sufficient evidence of construct validity.RESULTSA total of 2,846 participants completed the GENDER-Q Chest scale. For the GENDER-Q Chest, Nipples & Areolas, and Scars scales, 95% (21/22), 79% (15/19), and 100% (12/12) of hypotheses were accepted for each scale, respectively. Patients who underwent surgery and do not currently need revisions reported the highest satisfaction, while patients who had not yet undergone surgery reported the lowest satisfaction.CONCLUSIONThe GENDER-Q Chest scales evidenced construct validity to measure appearance of chest, nipples, and scars for individuals seeking or undergoing masculinizing gender-affirming chest surgery. The GENDER-Q Chest scales provide a robust, validated approach for assessing outcomes in this context and are well-suited for generating high-quality evidence on patient-reported outcomes.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"8 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148408051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONPoor operating room (OR) ergonomics pose risk of injury to OR staff, worsening patient outcomes and threatening workforce wellness and sustainability. How OR staff navigate ergonomic barriers in the interdisciplinary team environment was examined in this qualitative study.METHODSSemi-structured, open-ended interviews of surgeons, anaesthesiologists and OR nurses were conducted at single institution using a socio-material approach with interview-to-the-double. Transcripts were coded by two independent researchers. Themes in the data were outlined using the System Engineering Initiative for Patient Safety (SEIPS) framework.RESULTSFive major themes were identified. First, physical environment issues creating cognitive and physical frictions, such as tripping hazards and improper room layouts. Second, influence of social positionality, with hierarchy by role and experience and social dynamics leading to differential capacity to adjust. Third, team collaboration, with lack of interdisciplinary work and communication and high staff turnover. Fourth, burden of self-initiated work arounds, outlining conflict between system/organizational issues but individual solutions. Fifth, institutional support, with lack of leadership engagement. Participants suggested solutions including accommodations to foster a collaborative approach to managing discomfort in the OR, and new team communication tools.CONCLUSIONSErgonomic barriers were described within the work system of the SEIPS framework. Social positionality and differential levels of agency, as well as lack of team collaboration and misperceptions of others' roles, were central to ergonomic challenges. Conflicts between problems lying with the system/organization, but solution being left to individuals, were also central to challenges to optimal OR ergonomics.
{"title":"Making the OR work: a socio-material study of ergonomics in the operating room.","authors":"Alexis Mah,Csilla Kalocsai,Fahad Alam,Allia Karim,Jeremie Larouche,M Susan Hallbeck,Tara Cohen,Anna Ding,Jessica Armah,Julie Hallet, ","doi":"10.1093/bjs/znag083","DOIUrl":"https://doi.org/10.1093/bjs/znag083","url":null,"abstract":"INTRODUCTIONPoor operating room (OR) ergonomics pose risk of injury to OR staff, worsening patient outcomes and threatening workforce wellness and sustainability. How OR staff navigate ergonomic barriers in the interdisciplinary team environment was examined in this qualitative study.METHODSSemi-structured, open-ended interviews of surgeons, anaesthesiologists and OR nurses were conducted at single institution using a socio-material approach with interview-to-the-double. Transcripts were coded by two independent researchers. Themes in the data were outlined using the System Engineering Initiative for Patient Safety (SEIPS) framework.RESULTSFive major themes were identified. First, physical environment issues creating cognitive and physical frictions, such as tripping hazards and improper room layouts. Second, influence of social positionality, with hierarchy by role and experience and social dynamics leading to differential capacity to adjust. Third, team collaboration, with lack of interdisciplinary work and communication and high staff turnover. Fourth, burden of self-initiated work arounds, outlining conflict between system/organizational issues but individual solutions. Fifth, institutional support, with lack of leadership engagement. Participants suggested solutions including accommodations to foster a collaborative approach to managing discomfort in the OR, and new team communication tools.CONCLUSIONSErgonomic barriers were described within the work system of the SEIPS framework. Social positionality and differential levels of agency, as well as lack of team collaboration and misperceptions of others' roles, were central to ergonomic challenges. Conflicts between problems lying with the system/organization, but solution being left to individuals, were also central to challenges to optimal OR ergonomics.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDIntrathecal morphine (ITM) and continuous wound infiltration (CWI) are two alternatives to thoracic epidural analgesia in major abdominal surgery, but direct comparative studies are lacking. We evaluated whether ITM is noninferior to CWI after open pancreatoduodenectomy.METHODSAn open-label, randomised, noninferiority clinical trial conducted at a tertiary hospital. Adult patients undergoing elective open pancreatoduodenectomy were randomised 1:1 to receive either a single-shot ITM (0.2 mg) or bilateral preperitoneal CWI. Both groups received standardised multimodal and intravenous patient-controlled analgesia (IV-PCA). The primary outcome was the mean coughing pain score, averaged across 24, 48, and 72 h postoperatively, analysed for noninferiority using the 95% confidence interval (noninferiority margin: 1.0). Secondary outcomes included the mean resting pain score, pain score at each time point (2, 24, 48, and 72 h), IV-PCA fentanyl consumption, EuroQol 5-Dimension 5-Level utility score, and postoperative complications.RESULTSIn the per-protocol population (n = 92), ITM was noninferior to CWI for the primary outcome (ITM: 5.7 ± 1.7 vs. CWI: 6.1 ± 1.5; mean difference -0.5, 95% confidence interval -1.1 to 0.2). ITM was also noninferior to CWI regarding the mean resting pain score. ITM provided significantly lower pain scores at 2 h postoperatively, both at rest and on coughing, with a sustained reduction on coughing at 24 h and reduced fentanyl consumption. Otherwise comparable, ITM increased respiratory depression and pruritus within 24 h.CONCLUSIONITM provides noninferior overall and superior early analgesia to CWI after open pancreatoduodenectomy, although careful monitoring for early side effects is warranted.TRIAL REGISTRATIONClinicalTrials.gov Identifier (No. NCT06761989, https://clinicaltrials.gov/study/NCT06761989) registered on 30 December 2024.
{"title":"A randomized, noninferiority clinical trial of Single-Shot Intrathecal Morphine versus Continuous Wound Infiltration for postoperative pain control after open pancreatoduodenectomy.","authors":"Soohyuk Yoon,Taeyup Kim,Ho-Jin Lee,Nanhee Park,Hye-Sol Jung,Young Jae Cho,Wooil Kwon,Joon Seong Park,Chul-Woo Jung,Jin-Young Jang","doi":"10.1093/bjs/znag088","DOIUrl":"https://doi.org/10.1093/bjs/znag088","url":null,"abstract":"BACKGROUNDIntrathecal morphine (ITM) and continuous wound infiltration (CWI) are two alternatives to thoracic epidural analgesia in major abdominal surgery, but direct comparative studies are lacking. We evaluated whether ITM is noninferior to CWI after open pancreatoduodenectomy.METHODSAn open-label, randomised, noninferiority clinical trial conducted at a tertiary hospital. Adult patients undergoing elective open pancreatoduodenectomy were randomised 1:1 to receive either a single-shot ITM (0.2 mg) or bilateral preperitoneal CWI. Both groups received standardised multimodal and intravenous patient-controlled analgesia (IV-PCA). The primary outcome was the mean coughing pain score, averaged across 24, 48, and 72 h postoperatively, analysed for noninferiority using the 95% confidence interval (noninferiority margin: 1.0). Secondary outcomes included the mean resting pain score, pain score at each time point (2, 24, 48, and 72 h), IV-PCA fentanyl consumption, EuroQol 5-Dimension 5-Level utility score, and postoperative complications.RESULTSIn the per-protocol population (n = 92), ITM was noninferior to CWI for the primary outcome (ITM: 5.7 ± 1.7 vs. CWI: 6.1 ± 1.5; mean difference -0.5, 95% confidence interval -1.1 to 0.2). ITM was also noninferior to CWI regarding the mean resting pain score. ITM provided significantly lower pain scores at 2 h postoperatively, both at rest and on coughing, with a sustained reduction on coughing at 24 h and reduced fentanyl consumption. Otherwise comparable, ITM increased respiratory depression and pruritus within 24 h.CONCLUSIONITM provides noninferior overall and superior early analgesia to CWI after open pancreatoduodenectomy, although careful monitoring for early side effects is warranted.TRIAL REGISTRATIONClinicalTrials.gov Identifier (No. NCT06761989, https://clinicaltrials.gov/study/NCT06761989) registered on 30 December 2024.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"36 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jerry Dang,Yung Lee,Mélissa V Wills,J Mark Brown,Karen Madsen,Valentin Mocanu
INTRODUCTIONThe gut microbiome is a fundamental determinant of gastrointestinal physiology. It is essential in maintaining host homeostasis while also implicated in cancer pathogenesis and alteration in physiological response to surgical stress. This narrative review evaluates the microbiome's mechanistic role in surgical oncology, assessing it as a biomarker for risk stratification and an emerging therapeutic target.METHODThe current literature was synthesized to examine microbial impacts on tumourigenesis and perioperative surgical outcomes across the lower and upper gastrointestinal tracts (including the gut-lung axis), the hepatopancreatobiliary system, and extra-abdominal malignancies (breast cancer and melanoma).RESULTSDysbiotic microbial signatures, termed the oncobiome, actively drive tumour progression and immune evasion. Perioperative interventions induce acute microbial shifts linked to serious complications such as anastomotic leaks and pneumonia. Clinically, targeted modulation yields significant benefits as demonstrated by: perioperative synbiotics reducing infectious complications by 45% in colorectal surgery and 64% in major liver surgery. Furthermore, preoperative oral care reduces post-esophagectomy pneumonia by up to 50%, while Helicobacter pylori eradication halves metachronous gastric cancer risk. However, a detrimental "antibiotic paradox" exists in melanoma, where pre-treatment antibiotic exposure severely impairs immune checkpoint inhibitor efficacy. Conversely, faecal microbiota transplantation can reverse this immunotherapy resistance, achieving up to 80% response rates in trials.CONCLUSIONThe microbiome is a critical, modifiable determinant of both short-term surgical recovery and long-term oncologic survival. Future surgical oncology practice will need to integrate precision surgical microbiome-mediated biotherapeutics to optimise outcomes in multidisciplinary cancer care.
{"title":"The Gut Microbiome in Surgical Oncology: Mechanisms, Perioperative Outcomes, and Therapeutic Opportunities.","authors":"Jerry Dang,Yung Lee,Mélissa V Wills,J Mark Brown,Karen Madsen,Valentin Mocanu","doi":"10.1093/bjs/znag082","DOIUrl":"https://doi.org/10.1093/bjs/znag082","url":null,"abstract":"INTRODUCTIONThe gut microbiome is a fundamental determinant of gastrointestinal physiology. It is essential in maintaining host homeostasis while also implicated in cancer pathogenesis and alteration in physiological response to surgical stress. This narrative review evaluates the microbiome's mechanistic role in surgical oncology, assessing it as a biomarker for risk stratification and an emerging therapeutic target.METHODThe current literature was synthesized to examine microbial impacts on tumourigenesis and perioperative surgical outcomes across the lower and upper gastrointestinal tracts (including the gut-lung axis), the hepatopancreatobiliary system, and extra-abdominal malignancies (breast cancer and melanoma).RESULTSDysbiotic microbial signatures, termed the oncobiome, actively drive tumour progression and immune evasion. Perioperative interventions induce acute microbial shifts linked to serious complications such as anastomotic leaks and pneumonia. Clinically, targeted modulation yields significant benefits as demonstrated by: perioperative synbiotics reducing infectious complications by 45% in colorectal surgery and 64% in major liver surgery. Furthermore, preoperative oral care reduces post-esophagectomy pneumonia by up to 50%, while Helicobacter pylori eradication halves metachronous gastric cancer risk. However, a detrimental \"antibiotic paradox\" exists in melanoma, where pre-treatment antibiotic exposure severely impairs immune checkpoint inhibitor efficacy. Conversely, faecal microbiota transplantation can reverse this immunotherapy resistance, achieving up to 80% response rates in trials.CONCLUSIONThe microbiome is a critical, modifiable determinant of both short-term surgical recovery and long-term oncologic survival. Future surgical oncology practice will need to integrate precision surgical microbiome-mediated biotherapeutics to optimise outcomes in multidisciplinary cancer care.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"21 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148342397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siran Wan,Wei Lin,Xue Zhang,Saidi Hu,Chenchen Luo,Shunhong Zhang,Elaine Dos Ramos Amado Dos Ramos,Lucilia Fernandes de Almeida,Lin-Yong Zhao
BACKGROUNDCurrent guidelines endorse laparoscopy for non-obstetric abdominal surgery during pregnancy regardless of trimester, but recent data suggest trimester-specific fetal risks. This study compared maternal and fetal safety of laparoscopic versus open surgery, focusing on trimester-specific and pathology-stratified outcomes.METHODSA systematic review and meta-analysis followed PRISMA 2020 (CRD420261295995). PubMed, Embase and Cochrane Library were searched for comparative studies (randomised controlled trials and cohort studies) of laparoscopic versus open surgery for acute appendicitis, gallstone disease and adnexal masses. Random-effects meta-analysis synthesised data on fetal loss, preterm delivery, maternal complications and hospital stay.RESULTSTwenty-two studies comprising 28,160 pregnant women (15,786 laparoscopic, 12,374 open) were included. Laparoscopy was associated with a higher risk of fetal loss than open surgery (Odds ratio (OR) 2.02; 95% CI 1.40-2.92; P < 0.001). A first-trimester subgroup analysis showed a persistent trend towards higher fetal loss with laparoscopy (OR 1.35; 95% CI 0.84-2.19). Laparoscopy reduced preterm delivery (OR 0.56; 95% CI 0.34-0.94; P = 0.020) and maternal complications (OR 0.45; 95% CI 0.30-0.68; P < 0.001). Trimester-specific analysis revealed a significantly elevated risk of composite adverse fetal outcomes for laparoscopy during the second trimester (OR 2.35; 95% CI 1.15-4.77; P = 0.020) and a similar trend in the third trimester.CONCLUSIONLaparoscopy confers maternal benefits and reduces preterm delivery but is associated with higher fetal loss and elevated composite adverse outcomes in the second trimester.
背景：目前的指南支持在妊娠期间进行腹腔镜非产科腹部手术，无论妊娠期如何，但最近的数据表明妊娠期特有的胎儿风险。本研究比较了腹腔镜手术与开放手术的母婴安全性，重点关注妊娠特异性和病理分层结果。方法采用PRISMA 2020 （CRD420261295995）进行系统评价和meta分析。检索PubMed、Embase和Cochrane图书馆的比较研究（随机对照试验和队列研究），比较腹腔镜手术与开放手术治疗急性阑尾炎、胆结石疾病和附件肿块的疗效。随机效应荟萃分析综合了胎儿丢失、早产、产妇并发症和住院时间的数据。结果纳入22项研究，共28160例孕妇，其中腹腔镜15786例，开放12374例。腹腔镜手术与开放手术相比，胎儿丢失的风险更高(优势比（OR） 2.02；95% ci 1.40-2.92；P < 0.001)。早期妊娠亚组分析显示，腹腔镜手术导致胎儿丢失的持续趋势较高（OR 1.35; 95% CI 0.84-2.19）。腹腔镜检查减少了早产（OR 0.56; 95% CI 0.34-0.94; P = 0.020）和产妇并发症（OR 0.45; 95% CI 0.30-0.68; P < 0.001）。妊娠期特异性分析显示，在妊娠中期腹腔镜检查复合不良胎儿结局的风险显著升高（OR 2.35; 95% CI 1.15-4.77; P = 0.020），在妊娠晚期也有类似的趋势。结论腹腔镜手术对产妇有利，可减少早产，但与妊娠中期胎儿丢失和复合不良结局升高相关。
{"title":"Trimester-Specific Safety of Laparoscopic versus Open Abdominal Surgery During Pregnancy: A Systematic Review and Meta-analysis.","authors":"Siran Wan,Wei Lin,Xue Zhang,Saidi Hu,Chenchen Luo,Shunhong Zhang,Elaine Dos Ramos Amado Dos Ramos,Lucilia Fernandes de Almeida,Lin-Yong Zhao","doi":"10.1093/bjs/znag084","DOIUrl":"https://doi.org/10.1093/bjs/znag084","url":null,"abstract":"BACKGROUNDCurrent guidelines endorse laparoscopy for non-obstetric abdominal surgery during pregnancy regardless of trimester, but recent data suggest trimester-specific fetal risks. This study compared maternal and fetal safety of laparoscopic versus open surgery, focusing on trimester-specific and pathology-stratified outcomes.METHODSA systematic review and meta-analysis followed PRISMA 2020 (CRD420261295995). PubMed, Embase and Cochrane Library were searched for comparative studies (randomised controlled trials and cohort studies) of laparoscopic versus open surgery for acute appendicitis, gallstone disease and adnexal masses. Random-effects meta-analysis synthesised data on fetal loss, preterm delivery, maternal complications and hospital stay.RESULTSTwenty-two studies comprising 28,160 pregnant women (15,786 laparoscopic, 12,374 open) were included. Laparoscopy was associated with a higher risk of fetal loss than open surgery (Odds ratio (OR) 2.02; 95% CI 1.40-2.92; P < 0.001). A first-trimester subgroup analysis showed a persistent trend towards higher fetal loss with laparoscopy (OR 1.35; 95% CI 0.84-2.19). Laparoscopy reduced preterm delivery (OR 0.56; 95% CI 0.34-0.94; P = 0.020) and maternal complications (OR 0.45; 95% CI 0.30-0.68; P < 0.001). Trimester-specific analysis revealed a significantly elevated risk of composite adverse fetal outcomes for laparoscopy during the second trimester (OR 2.35; 95% CI 1.15-4.77; P = 0.020) and a similar trend in the third trimester.CONCLUSIONLaparoscopy confers maternal benefits and reduces preterm delivery but is associated with higher fetal loss and elevated composite adverse outcomes in the second trimester.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"197 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148342471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M H Elise van Driel,Hidde Swartjes,Jobbe M G Lemmens,Seyed M Qaderi,Steven Teerenstra,Jose A E Custers,Marloes A G Elferink,Bob J van Wely,Johanne G Bloemen,Wilhelmina M U van Grevenstein,Peter van Duijvendijk,Emiel G G Verdaasdonk,Marnix A J de Roos,Veerle M H Coupé,Geraldine R Vink,Cornelis Verhoef,Dirk J Grünhagen,Johannes H W de Wilt
INTRODUCTIONColorectal cancer (CRC) incidence is rising, consequentially traditional follow-up care models are increasingly unsustainable. Patient-led, home-based follow-up (PHFU) may offer a promising alternative to reduce hospital visits while maintaining patient well-being.METHODSThe DISTANCE trial is a stepped-wedge cluster randomised trial conducted in six hospitals in the Netherlands. A total of 354 stage I-III CRC survivors, disease-free at 12 months post-surgery, assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (QoL, EORTC QLQ-C30), cancer-related worry (CWS), and psychological distress (HADS).RESULTSIn the intention-to-treat (ITT) analysis, no significant difference in hospital contacts was observed. In the as-treated (AT) analysis, PHFU reduced hospital contacts by 38% compared to standard follow-up (RR 0.62, 95% CI 0.51-0.75, p < 0.001). There was substantial crossover, with 117 patients assigned to PHFU receiving standard follow-up and 10 patients assigned to standard follow-up receiving PHFU. No significant differences were found in QoL or psychological distress between the two groups.CONCLUSIONThe DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.TOC Summary.
结直肠癌（CRC）的发病率正在上升，因此传统的随访治疗模式越来越难以为继。以患者为主导、以家庭为基础的随访（PHFU）可能提供一种有希望的替代方案，以减少住院次数，同时保持患者的健康。方法DISTANCE试验是一项在荷兰6家医院进行的楔形聚类随机试验。共有354例I-III期结直肠癌幸存者，术后12个月无疾病，分配到PHFU或标准随访。主要终点是医院接触者的数量。次要终点包括生活质量（QoL, EORTC QLQ-C30）、癌症相关担忧（CWS）和心理困扰（HADS）。结果在意向治疗（ITT）分析中，医院接触者无显著差异。在治疗后（AT）分析中，与标准随访相比，PHFU减少了38%的医院接触（RR 0.62, 95% CI 0.51-0.75, p < 0.001）。有大量交叉，117例患者被分配到PHFU接受标准随访，10例患者被分配到标准随访接受PHFU。两组患者的生活质量和心理困扰均无显著差异。结论：DISTANCE试验表明，对于结直肠癌幸存者来说，PHFU是一种可行且有效的替代标准医院随访的方法。TOC总结。
{"title":"Patient-led, home-based follow-up for colorectal cancer: the DISTANCE multicentre stepped-wedge cluster-randomised trial.","authors":"M H Elise van Driel,Hidde Swartjes,Jobbe M G Lemmens,Seyed M Qaderi,Steven Teerenstra,Jose A E Custers,Marloes A G Elferink,Bob J van Wely,Johanne G Bloemen,Wilhelmina M U van Grevenstein,Peter van Duijvendijk,Emiel G G Verdaasdonk,Marnix A J de Roos,Veerle M H Coupé,Geraldine R Vink,Cornelis Verhoef,Dirk J Grünhagen,Johannes H W de Wilt","doi":"10.1093/bjs/znag081","DOIUrl":"https://doi.org/10.1093/bjs/znag081","url":null,"abstract":"INTRODUCTIONColorectal cancer (CRC) incidence is rising, consequentially traditional follow-up care models are increasingly unsustainable. Patient-led, home-based follow-up (PHFU) may offer a promising alternative to reduce hospital visits while maintaining patient well-being.METHODSThe DISTANCE trial is a stepped-wedge cluster randomised trial conducted in six hospitals in the Netherlands. A total of 354 stage I-III CRC survivors, disease-free at 12 months post-surgery, assigned to either PHFU or standard follow-up. The primary endpoint was the number of hospital contacts. Secondary endpoints included quality of life (QoL, EORTC QLQ-C30), cancer-related worry (CWS), and psychological distress (HADS).RESULTSIn the intention-to-treat (ITT) analysis, no significant difference in hospital contacts was observed. In the as-treated (AT) analysis, PHFU reduced hospital contacts by 38% compared to standard follow-up (RR 0.62, 95% CI 0.51-0.75, p < 0.001). There was substantial crossover, with 117 patients assigned to PHFU receiving standard follow-up and 10 patients assigned to standard follow-up receiving PHFU. No significant differences were found in QoL or psychological distress between the two groups.CONCLUSIONThe DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors.TOC Summary.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"22 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148322670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas F Stoop,Leonard W F Seelen,Freek R van 't Land,Jacobien C M Scheepens,Mahsoem Ali,Anna C van der Hout,B Marion van der Kolk,Bert A Bonsing,Daan J Lips,Eric R Manusama,François E J A Willemsen,Freek Daams,Geert Kazemier,Gijs A Patijn,Ignace H de Hingh,Jan H Wijsman,Jennifer Schreinemakers,Joris I Erdmann,J Sven D Mieog,Joost M Klaase,Judith A C Rietjens,Koop Bosscha,Lysanne P M Beuk,Maarten W Nijkamp,Marcel den Dulk,Marnix P M Kop,Mike S L Liem,Misha Luyer,Martijn W J Stommel,Olivier R Busch,Sebastiaan Festen,Stefan Bouwense,Tom M Karsten,Tom W van Ravens,Ulff P Neumann,Vincent E de Meijer,Vincent B Nieuwenhuijs,Werner A Draaisma,Wouter Derksen,Thomas L Bollen,Bas Groot Koerkamp,Casper H J van Eijck,I Quintus Molenaar,Christopher L Wolfgang,Marco Del Chiaro,Matthew H G Katz,Thilo Hackert,Johanna W Wilmink,Hjalmar C van Santvoort,Roeland F de Wilde,Marc G Besselink,
BACKGROUNDIn expert centers, surgical resection rates of locally advanced pancreatic cancer (LAPC) following induction chemotherapy have increased beyond 20% with subsequent 25% five-year overall survival (OS). In the Netherlands, however, the historical low 8% LAPC resection rate compared with 23% in international expert centers reflects relative reluctance. Thereby, opportunities to achieve long-term survival in appropriately selected patients may be missed. This study evaluated whether nationwide implementation of international multidisciplinary best-practice for LAPC management is feasible while maintaining surgical safety benchmarks (in-hospital/30-day major morbidity <50% and mortality ≤5%).METHODSA multidisciplinary protocol was designed in collaboration with four international experts and prospectively implemented nationwide within the Dutch Pancreatic Cancer Group (DPCG) (2022-2024). This observational cohort included consecutive patients diagnosed with LAPC, defined by DPCG criteria. Eligible patients had radiologically non-progressive disease after at least four months of multi-agent chemotherapy. All patients who underwent resection were included in this safety analysis. A predefined sub-group analysis included patients with National Comprehensive Cancer Network (NCCN) LAPC. Primary outcomes included in-hospital/30-day major morbidity (i.e., Clavien-Dindo grade ≥IIIa) and mortality. The expected number of resections was 53.RESULTSOverall, 180 patients with LAPC underwent surgical exploration, of whom 155 (86%) underwent resection in 11 centers. Most (74%) resections were performed in the three LAPC surgical centers. Extended resections were performed in 77% of patients, including portomesenteric venous (60%), multivisceral (23%), and arterial (21%) resections. In-hospital/30-day major morbidity rate was 44% and mortality rate was 0.6%, both within pre-established safety benchmarks. Benchmarks were also reached for patients with NCCN LAPC (49% major morbidity, 2% mortality).CONCLUSIONNationwide implementation of the international best-practice for LAPC was feasible with nearly three times more resections performed than expected, while morbidity and mortality remained well within predefined safety benchmarks.
{"title":"Surgical Outcomes from Nationwide Implementation of the International Best-Practice for Locally Advanced Pancreatic Cancer (PREOPANC-4) study.","authors":"Thomas F Stoop,Leonard W F Seelen,Freek R van 't Land,Jacobien C M Scheepens,Mahsoem Ali,Anna C van der Hout,B Marion van der Kolk,Bert A Bonsing,Daan J Lips,Eric R Manusama,François E J A Willemsen,Freek Daams,Geert Kazemier,Gijs A Patijn,Ignace H de Hingh,Jan H Wijsman,Jennifer Schreinemakers,Joris I Erdmann,J Sven D Mieog,Joost M Klaase,Judith A C Rietjens,Koop Bosscha,Lysanne P M Beuk,Maarten W Nijkamp,Marcel den Dulk,Marnix P M Kop,Mike S L Liem,Misha Luyer,Martijn W J Stommel,Olivier R Busch,Sebastiaan Festen,Stefan Bouwense,Tom M Karsten,Tom W van Ravens,Ulff P Neumann,Vincent E de Meijer,Vincent B Nieuwenhuijs,Werner A Draaisma,Wouter Derksen,Thomas L Bollen,Bas Groot Koerkamp,Casper H J van Eijck,I Quintus Molenaar,Christopher L Wolfgang,Marco Del Chiaro,Matthew H G Katz,Thilo Hackert,Johanna W Wilmink,Hjalmar C van Santvoort,Roeland F de Wilde,Marc G Besselink, ","doi":"10.1093/bjs/znag075","DOIUrl":"https://doi.org/10.1093/bjs/znag075","url":null,"abstract":"BACKGROUNDIn expert centers, surgical resection rates of locally advanced pancreatic cancer (LAPC) following induction chemotherapy have increased beyond 20% with subsequent 25% five-year overall survival (OS). In the Netherlands, however, the historical low 8% LAPC resection rate compared with 23% in international expert centers reflects relative reluctance. Thereby, opportunities to achieve long-term survival in appropriately selected patients may be missed. This study evaluated whether nationwide implementation of international multidisciplinary best-practice for LAPC management is feasible while maintaining surgical safety benchmarks (in-hospital/30-day major morbidity <50% and mortality ≤5%).METHODSA multidisciplinary protocol was designed in collaboration with four international experts and prospectively implemented nationwide within the Dutch Pancreatic Cancer Group (DPCG) (2022-2024). This observational cohort included consecutive patients diagnosed with LAPC, defined by DPCG criteria. Eligible patients had radiologically non-progressive disease after at least four months of multi-agent chemotherapy. All patients who underwent resection were included in this safety analysis. A predefined sub-group analysis included patients with National Comprehensive Cancer Network (NCCN) LAPC. Primary outcomes included in-hospital/30-day major morbidity (i.e., Clavien-Dindo grade ≥IIIa) and mortality. The expected number of resections was 53.RESULTSOverall, 180 patients with LAPC underwent surgical exploration, of whom 155 (86%) underwent resection in 11 centers. Most (74%) resections were performed in the three LAPC surgical centers. Extended resections were performed in 77% of patients, including portomesenteric venous (60%), multivisceral (23%), and arterial (21%) resections. In-hospital/30-day major morbidity rate was 44% and mortality rate was 0.6%, both within pre-established safety benchmarks. Benchmarks were also reached for patients with NCCN LAPC (49% major morbidity, 2% mortality).CONCLUSIONNationwide implementation of the international best-practice for LAPC was feasible with nearly three times more resections performed than expected, while morbidity and mortality remained well within predefined safety benchmarks.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"32 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148286836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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