Sanju Sobnach,Haytham Bayadsi,Urda Kotze,Hanna Nyström,C Wendy Spearman,Mark Sonderup,Inae Kim,Keith Venter,Marc Bernon,Muhammad Emmamally,Luiz F Zerbini,Oskar Hemmingsson,Eduard Jonas
INTRODUCTIONSub-Saharan Africa carries a disproportionate burden of hepatocellular carcinoma, yet clinical guidelines used on the African sub-continent are extrapolated from high-income countries. The presentation, treatment and outcomes of hepatocellular carcinoma between liver referral centres in South Africa and Sweden were compared to examine the limitations of applying high-income countries-derived guidelines in sub-Saharan Africa.METHODSThis was a comparative cohort study of adult patients with hepatocellular carcinoma treated from 2012 to 2023 in a referral centre in South Africa and Sweden respectively. Main outcome was overall survival. Secondary outcome was treatment-specific survival.RESULTSOf 959 patients included 455 and 504 were treated in South-Africa and Sweden respectively. Patients in South Africa were younger (median 50 vs. 71 years, P<0.001) and predominantly had hepatitis B virus-related hepatocellular carcinoma (60% vs. 3.6%, P<0.001). They presented with more advanced liver dysfunction, more frequent metastases and had more advanced BCLC stages. Curative-intended therapies (ablation, liver resection, liver transplantation) were offered to 9.2% and 42.5% of patients respectively (P<0.001). One, three, and five-year survival were 17.8%, 7.7% and 5.3%, respectively versus 58.9%, 35.3% and 26.2% respectively (P<0.001). Survival was consistently lower in the patients in South Africa when comparing treatment-specific cohorts.CONCLUSIONSMarked disparities in disease presentation, access to treatment and survival were observed between regions. Tailored regional guidelines are urgently needed to address these inequities and improve outcomes.
{"title":"Global disparities in hepatocellular carcinoma outcomes: multicentre study.","authors":"Sanju Sobnach,Haytham Bayadsi,Urda Kotze,Hanna Nyström,C Wendy Spearman,Mark Sonderup,Inae Kim,Keith Venter,Marc Bernon,Muhammad Emmamally,Luiz F Zerbini,Oskar Hemmingsson,Eduard Jonas","doi":"10.1093/bjs/znag079","DOIUrl":"https://doi.org/10.1093/bjs/znag079","url":null,"abstract":"INTRODUCTIONSub-Saharan Africa carries a disproportionate burden of hepatocellular carcinoma, yet clinical guidelines used on the African sub-continent are extrapolated from high-income countries. The presentation, treatment and outcomes of hepatocellular carcinoma between liver referral centres in South Africa and Sweden were compared to examine the limitations of applying high-income countries-derived guidelines in sub-Saharan Africa.METHODSThis was a comparative cohort study of adult patients with hepatocellular carcinoma treated from 2012 to 2023 in a referral centre in South Africa and Sweden respectively. Main outcome was overall survival. Secondary outcome was treatment-specific survival.RESULTSOf 959 patients included 455 and 504 were treated in South-Africa and Sweden respectively. Patients in South Africa were younger (median 50 vs. 71 years, P<0.001) and predominantly had hepatitis B virus-related hepatocellular carcinoma (60% vs. 3.6%, P<0.001). They presented with more advanced liver dysfunction, more frequent metastases and had more advanced BCLC stages. Curative-intended therapies (ablation, liver resection, liver transplantation) were offered to 9.2% and 42.5% of patients respectively (P<0.001). One, three, and five-year survival were 17.8%, 7.7% and 5.3%, respectively versus 58.9%, 35.3% and 26.2% respectively (P<0.001). Survival was consistently lower in the patients in South Africa when comparing treatment-specific cohorts.CONCLUSIONSMarked disparities in disease presentation, access to treatment and survival were observed between regions. Tailored regional guidelines are urgently needed to address these inequities and improve outcomes.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"21 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298948","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}
Lore E de Vreeze,Sanne C Maat,Johannes R Anema,Robertine van Baren,Jasper V Been,Mart H M Bender,Hanneke M van Dongen,Hester R Langeveld-Benders,Ruben G J Visschers,Jos W R Twisk,Gerda W Zijp,Ernest L W van Heurn,Joep P M Derikx
{"title":"Reduced pain and discomfort after surgical repair of inguinal hernia in infants: secondary outcome analysis of the randomized controlled HERNIIA-trial.","authors":"Lore E de Vreeze,Sanne C Maat,Johannes R Anema,Robertine van Baren,Jasper V Been,Mart H M Bender,Hanneke M van Dongen,Hester R Langeveld-Benders,Ruben G J Visschers,Jos W R Twisk,Gerda W Zijp,Ernest L W van Heurn,Joep P M Derikx","doi":"10.1093/bjs/znag064","DOIUrl":"https://doi.org/10.1093/bjs/znag064","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"21 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148286845","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}
{"title":"Correction to: Reduced secretory efficiency in parathyroid carcinoma: diagnostic value of the PTH-to-tumour-volume ratio.","authors":"","doi":"10.1093/bjs/znag071","DOIUrl":"https://doi.org/10.1093/bjs/znag071","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"144 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148299340","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}
William R G Perry,Kilian G M Brown,Elaine Burns,Quentin Denost,Frank Frizelle,Thomas E Glover,Tamara Glyn,Rondell P Graham,Alexander Heriot,Amit Merchea,Aaron Quyn,Peter Sagar,Michael J Solomon,Gregory Thomas,Jim P Tiernan,Gregory A Turner,Satish Warrier,Verity Wood, ,John T Jenkins,Eric Dozois
BACKGROUNDPresacral tumours are rare and heterogeneous lesions arising within a complex anatomical space, resulting in variability in diagnosis and management. Increasing incidental detection and evolving surgical and oncological strategies have highlighted the need for contemporary guidance. This study develops an international expert consensus on the optimal diagnosis and management of presacral tumours.METHODSAn international panel of colorectal surgeons from high-volume units was convened. Evidence- and practice-based statements were developed after domain-based literature reviews and refined through five online and two in-person meetings. Consensus was achieved using a modified Delphi process with anonymous voting.RESULTSSixteen colorectal surgeons participated in the study. Ten domains were identified resulting in the development twenty-two statements based on expert opinion and retrospective studies. After two rounds, unanimous (100%) agreement was achieved for all statements. High-resolution MRI with structured synoptic reporting is endorsed as central to risk stratification. Selective image-guided transperineal or parasacral biopsy is recommended for high-risk lesions where histology would alter management. Complete surgical resection is defined as the operative goal, with approach tailored to tumour biology and anatomy; minimally invasive surgery is considered appropriate in selected cases. Non-operative surveillance is supported for carefully selected asymptomatic, low-risk cystic lesions. Postoperative surveillance is recommended in a risk-adapted manner according to histopathology and margin status.CONCLUSIONThis international consensus provides a pragmatic, risk-stratified framework for the multidisciplinary diagnosis and management of presacral tumours. These recommendations aim to reduce practice variation, support decision-making in specialised centres, and inform future prospective collaborative research.
{"title":"Presacral Tumours: an international consensus on diagnosis and management.","authors":"William R G Perry,Kilian G M Brown,Elaine Burns,Quentin Denost,Frank Frizelle,Thomas E Glover,Tamara Glyn,Rondell P Graham,Alexander Heriot,Amit Merchea,Aaron Quyn,Peter Sagar,Michael J Solomon,Gregory Thomas,Jim P Tiernan,Gregory A Turner,Satish Warrier,Verity Wood, ,John T Jenkins,Eric Dozois","doi":"10.1093/bjs/znag053","DOIUrl":"https://doi.org/10.1093/bjs/znag053","url":null,"abstract":"BACKGROUNDPresacral tumours are rare and heterogeneous lesions arising within a complex anatomical space, resulting in variability in diagnosis and management. Increasing incidental detection and evolving surgical and oncological strategies have highlighted the need for contemporary guidance. This study develops an international expert consensus on the optimal diagnosis and management of presacral tumours.METHODSAn international panel of colorectal surgeons from high-volume units was convened. Evidence- and practice-based statements were developed after domain-based literature reviews and refined through five online and two in-person meetings. Consensus was achieved using a modified Delphi process with anonymous voting.RESULTSSixteen colorectal surgeons participated in the study. Ten domains were identified resulting in the development twenty-two statements based on expert opinion and retrospective studies. After two rounds, unanimous (100%) agreement was achieved for all statements. High-resolution MRI with structured synoptic reporting is endorsed as central to risk stratification. Selective image-guided transperineal or parasacral biopsy is recommended for high-risk lesions where histology would alter management. Complete surgical resection is defined as the operative goal, with approach tailored to tumour biology and anatomy; minimally invasive surgery is considered appropriate in selected cases. Non-operative surveillance is supported for carefully selected asymptomatic, low-risk cystic lesions. Postoperative surveillance is recommended in a risk-adapted manner according to histopathology and margin status.CONCLUSIONThis international consensus provides a pragmatic, risk-stratified framework for the multidisciplinary diagnosis and management of presacral tumours. These recommendations aim to reduce practice variation, support decision-making in specialised centres, and inform future prospective collaborative research.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"2 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754570","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}
Andrew Conner,Melissa V Wills,Salvador Navarrete,Jerry T Dang,Robert Bechara,Biniam Kidane,Siva Raja,Matthew Kroh,Dennis Hong,Yung Lee
Achalasia is a rare, progressive oesophageal motility disorder defined by impaired lower oesophageal sphincter relaxation and absent peristalsis, leading to dysphagia, regurgitation, chest pain, weight loss, and increased long-term risks of aspiration and malignancy. Management has evolved from open surgical myotomy to minimally invasive laparoscopic and robotic techniques and, more recently, peroral endoscopic myotomy (POEM). This review summarises contemporary diagnostic strategies, including high-resolution manometry, timed barium oesophagram, endoscopy, and emerging applications of impedance planimetry, and critically appraises current endoscopic and surgical therapies. The review compares outcomes of pneumatic dilation, botulinum toxin injection, minimally invasive Heller myotomy with fundoplication, POEM, POEM with fundoplication, and newer approaches for advanced disease such as per-oral oesophageal plication and oesophagectomy, integrating data from randomised trials and long-term cohort studies. Key issues including post-treatment gastroesophageal reflux, cancer surveillance, and management of recurrent or refractory symptoms are addressed. Treatment selection is emphasised as individualised, incorporating manometric subtype, oesophageal morphology, patient comorbidity, institutional expertise, procedural durability, complication profiles, and evolving guideline recommendations across international expert consensus groups. Contemporary multimodal therapy enables durable symptom control and meaningful quality-of-life improvement for most patients, while ongoing innovation and longer-term follow-up will continue to refine treatment algorithms and standards of care.
{"title":"Modern Treatment for Achalasia: Endoscopic and Surgical therapies.","authors":"Andrew Conner,Melissa V Wills,Salvador Navarrete,Jerry T Dang,Robert Bechara,Biniam Kidane,Siva Raja,Matthew Kroh,Dennis Hong,Yung Lee","doi":"10.1093/bjs/znag046","DOIUrl":"https://doi.org/10.1093/bjs/znag046","url":null,"abstract":"Achalasia is a rare, progressive oesophageal motility disorder defined by impaired lower oesophageal sphincter relaxation and absent peristalsis, leading to dysphagia, regurgitation, chest pain, weight loss, and increased long-term risks of aspiration and malignancy. Management has evolved from open surgical myotomy to minimally invasive laparoscopic and robotic techniques and, more recently, peroral endoscopic myotomy (POEM). This review summarises contemporary diagnostic strategies, including high-resolution manometry, timed barium oesophagram, endoscopy, and emerging applications of impedance planimetry, and critically appraises current endoscopic and surgical therapies. The review compares outcomes of pneumatic dilation, botulinum toxin injection, minimally invasive Heller myotomy with fundoplication, POEM, POEM with fundoplication, and newer approaches for advanced disease such as per-oral oesophageal plication and oesophagectomy, integrating data from randomised trials and long-term cohort studies. Key issues including post-treatment gastroesophageal reflux, cancer surveillance, and management of recurrent or refractory symptoms are addressed. Treatment selection is emphasised as individualised, incorporating manometric subtype, oesophageal morphology, patient comorbidity, institutional expertise, procedural durability, complication profiles, and evolving guideline recommendations across international expert consensus groups. Contemporary multimodal therapy enables durable symptom control and meaningful quality-of-life improvement for most patients, while ongoing innovation and longer-term follow-up will continue to refine treatment algorithms and standards of care.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"13 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751408","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}
Jane McClements,Wan Teng Lee,Amanda Koh,Harivinthan Sellappan,Lauren Blackburn,Adam Brooks,Gemma Nixon,Nabeel Merali,Adam Frampton,Danial Safavi,Brian Davidson,Michael Feretis,Bobby V M Dasari,Sirr Ling Chin,Dimitrios Karavias,Alistair Rowcroft,James Lucocq,Ewen M Harrison,Victoria Morrison-Jones,Fenella Welsh,Adithya Pathanki,Gabriele Marangoni,Paris Bruno,James Skipworth,Nicola Colucci,Vasilis Kosmoliaptsis,Lawrence O'Leary,Hassan Malik,Albasheer Hamadalnile,Krishna Menon,Waqqas Patel,Mohamed Bekheit,Lulu Tanno,Michael Silva,Christopher Brown,Nagappan Kumar,Joel Triance,Nehal Shah,Tareq Alsaoudi,Neil Bhardwaj,Hussein Nassar,Omar Mownah,Kai Tai Derek Yeung,Ricky Bhogal,Ruth Blanco-Colino,Shahid Farid,Rami Aljaberi,Sanjay Pandanaboyana,Omar Abdelmohsin,Somaiah Aroori,Daisy Evans,Tejinderjit Athwal,J Peter A Lodge,Dhanwant Gomez
INTRODUCTIONTo provide contemporary, real-world data on the management approaches and survival outcomes of patients with incidental gallbladder cancer (GBC) following cholecystectomy in the United Kingdom. The secondary aim was to identify prognostic factors associated with survival.METHODSPatients diagnosed with incidental GBC following cholecystectomy between January 2014 and December 2022 across 24 centres were included. Data collected comprised demographics, treatment details, histopathological findings and survival outcomes.RESULTSDuring the study period, 285 patients had incidental GBC. Median follow-up was 31 months, with 5-year disease-free (DFS) and overall (OS) survival of 41.5% and 45.1%, respectively. Of the 193 (67.7%) patients who underwent liver resection, most (97.9%) underwent segment 4B/5 resection. Patients with incidental GBC who underwent liver resection had significantly improved DFS (51 vs 15 months, p<0.001) and OS (72 vs 26 months, p<0.001) compared with those who did not. In addition, patients who completed adjuvant chemotherapy had better DFS (35 vs 15 months, p=0.021) and OS (47 vs 26 months, p=0.009) compared to those who did not. On multivariable analysis, nodal metastases were independently associated with poorer DFS (HR 2.04, 95% CI 1.30-3.20, p=0.002), while advanced tumour (T3-T4) stage (HR 1.70, 95% CI 1.04-2.77, p=0.034) and nodal metastases (HR 2.15, 95% CI 1.33-3.48, p=0.002) predicted poorer OS.CONCLUSIONPatients who underwent liver resection after incidental GBC had significantly better survival than those who did not proceed to further surgery. Adverse tumour biology was associated with poorer survival.
目的：提供英国胆囊切除术后偶发胆囊癌（GBC）患者的管理方法和生存结果的当代真实数据。次要目的是确定与生存相关的预后因素。方法纳入2014年1月至2022年12月24个中心的胆囊切除术后诊断为偶发性GBC的患者。收集的数据包括人口统计学、治疗细节、组织病理学结果和生存结果。结果研究期间，285例患者发生偶发GBC。中位随访31个月，5年无病生存率（DFS）和总生存率（OS）分别为41.5%和45.1%。在193例（67.7%）行肝切除术的患者中，大多数（97.9%）行4B/5节段切除术。与未行肝切除术的患者相比，行肝切除术的偶发GBC患者的DFS（51个月vs 15个月，p<0.001）和OS（72个月vs 26个月，p<0.001）显著改善。此外，与未完成辅助化疗的患者相比，完成辅助化疗的患者有更好的DFS （35 vs 15个月，p=0.021）和OS （47 vs 26个月，p=0.009）。在多变量分析中，淋巴结转移与较差的DFS独立相关（HR 2.04, 95% CI 1.30-3.20, p=0.002），而晚期肿瘤（T3-T4）阶段（HR 1.70, 95% CI 1.04-2.77, p=0.034）和淋巴结转移（HR 2.15, 95% CI 1.33-3.48, p=0.002）预测较差的OS。结论：偶发性GBC术后行肝切除术的患者生存率明显高于未行进一步手术的患者。不良的肿瘤生物学与较差的生存率相关。
{"title":"Management of incidental gallbladder cancer in a nationwide CAPBIL study.","authors":"Jane McClements,Wan Teng Lee,Amanda Koh,Harivinthan Sellappan,Lauren Blackburn,Adam Brooks,Gemma Nixon,Nabeel Merali,Adam Frampton,Danial Safavi,Brian Davidson,Michael Feretis,Bobby V M Dasari,Sirr Ling Chin,Dimitrios Karavias,Alistair Rowcroft,James Lucocq,Ewen M Harrison,Victoria Morrison-Jones,Fenella Welsh,Adithya Pathanki,Gabriele Marangoni,Paris Bruno,James Skipworth,Nicola Colucci,Vasilis Kosmoliaptsis,Lawrence O'Leary,Hassan Malik,Albasheer Hamadalnile,Krishna Menon,Waqqas Patel,Mohamed Bekheit,Lulu Tanno,Michael Silva,Christopher Brown,Nagappan Kumar,Joel Triance,Nehal Shah,Tareq Alsaoudi,Neil Bhardwaj,Hussein Nassar,Omar Mownah,Kai Tai Derek Yeung,Ricky Bhogal,Ruth Blanco-Colino,Shahid Farid,Rami Aljaberi,Sanjay Pandanaboyana,Omar Abdelmohsin,Somaiah Aroori,Daisy Evans,Tejinderjit Athwal,J Peter A Lodge,Dhanwant Gomez","doi":"10.1093/bjs/znag050","DOIUrl":"https://doi.org/10.1093/bjs/znag050","url":null,"abstract":"INTRODUCTIONTo provide contemporary, real-world data on the management approaches and survival outcomes of patients with incidental gallbladder cancer (GBC) following cholecystectomy in the United Kingdom. The secondary aim was to identify prognostic factors associated with survival.METHODSPatients diagnosed with incidental GBC following cholecystectomy between January 2014 and December 2022 across 24 centres were included. Data collected comprised demographics, treatment details, histopathological findings and survival outcomes.RESULTSDuring the study period, 285 patients had incidental GBC. Median follow-up was 31 months, with 5-year disease-free (DFS) and overall (OS) survival of 41.5% and 45.1%, respectively. Of the 193 (67.7%) patients who underwent liver resection, most (97.9%) underwent segment 4B/5 resection. Patients with incidental GBC who underwent liver resection had significantly improved DFS (51 vs 15 months, p<0.001) and OS (72 vs 26 months, p<0.001) compared with those who did not. In addition, patients who completed adjuvant chemotherapy had better DFS (35 vs 15 months, p=0.021) and OS (47 vs 26 months, p=0.009) compared to those who did not. On multivariable analysis, nodal metastases were independently associated with poorer DFS (HR 2.04, 95% CI 1.30-3.20, p=0.002), while advanced tumour (T3-T4) stage (HR 1.70, 95% CI 1.04-2.77, p=0.034) and nodal metastases (HR 2.15, 95% CI 1.33-3.48, p=0.002) predicted poorer OS.CONCLUSIONPatients who underwent liver resection after incidental GBC had significantly better survival than those who did not proceed to further surgery. Adverse tumour biology was associated with poorer survival.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"17 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731341","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}
Emma Söderberg,Fredrik Wärnberg,Anna-Karin Wennstig,Greger Nilsson,Hans Garmo,Lars Holmberg,Malin Sund,Charlotta Wadsten
BACKGROUNDThe prognostic relevance of multifocal and multicentric breast cancer remains unclear and current staging systems do not consider focality. The aim was to explore whether women with multifocal breast cancer have less favourable tumour characteristics and worse survival compared to women with unifocal breast cancer.METHODSPatient and tumour characteristics were obtained from Breast Cancer Data Base Sweden 3.0 which include all Swedish women operated for invasive breast cancer between 2008 and 2019. Overall and breast cancer-specific survival rates were calculated using the Kaplan-Meier method, and multivariable analysis was used to identify independent predictors of survival using the Cox proportional hazard model.RESULTSIn 71,607 included women, 59,445 (83.2%) had unifocal breast cancer, 7,286 (10.2%) had multifocal breast cancer with 2 invasive foci, and 4,688 (6.6%) had ≥3 invasive foci. Multifocal breast cancer was associated with higher T- and N-categories, compared to unifocal breast cancer. Median follow-up time was 5.96 years (interquartile range 3.07-8.80 years). The breast cancer-specific 10-year survival probabilities were 86.1%, 86.5%, and 88.5% for multifocal breast cancer with ≥3 foci, multifocal breast cancer with 2 foci, and unifocal breast cancer, respectively. In a multivariable analysis adjusted for patient and tumour characteristics, the hazard ratio for breast cancer-specific death was 1.17 (95% confidence interval, 1.03-1.32) in cases of multifocal breast cancer with ≥3 foci compared to those with unifocal breast cancer. There was no statistically significant difference in overall survival between the three groups.CONCLUSIONThe current study suggests that multifocality when compared to unifocal breast cancer carries additional prognostic information over traditional tumour characteristics.
{"title":"Comparing multifocality to unifocal breast cancer and the relation to survival: a national cohort study.","authors":"Emma Söderberg,Fredrik Wärnberg,Anna-Karin Wennstig,Greger Nilsson,Hans Garmo,Lars Holmberg,Malin Sund,Charlotta Wadsten","doi":"10.1093/bjs/znag033","DOIUrl":"https://doi.org/10.1093/bjs/znag033","url":null,"abstract":"BACKGROUNDThe prognostic relevance of multifocal and multicentric breast cancer remains unclear and current staging systems do not consider focality. The aim was to explore whether women with multifocal breast cancer have less favourable tumour characteristics and worse survival compared to women with unifocal breast cancer.METHODSPatient and tumour characteristics were obtained from Breast Cancer Data Base Sweden 3.0 which include all Swedish women operated for invasive breast cancer between 2008 and 2019. Overall and breast cancer-specific survival rates were calculated using the Kaplan-Meier method, and multivariable analysis was used to identify independent predictors of survival using the Cox proportional hazard model.RESULTSIn 71,607 included women, 59,445 (83.2%) had unifocal breast cancer, 7,286 (10.2%) had multifocal breast cancer with 2 invasive foci, and 4,688 (6.6%) had ≥3 invasive foci. Multifocal breast cancer was associated with higher T- and N-categories, compared to unifocal breast cancer. Median follow-up time was 5.96 years (interquartile range 3.07-8.80 years). The breast cancer-specific 10-year survival probabilities were 86.1%, 86.5%, and 88.5% for multifocal breast cancer with ≥3 foci, multifocal breast cancer with 2 foci, and unifocal breast cancer, respectively. In a multivariable analysis adjusted for patient and tumour characteristics, the hazard ratio for breast cancer-specific death was 1.17 (95% confidence interval, 1.03-1.32) in cases of multifocal breast cancer with ≥3 foci compared to those with unifocal breast cancer. There was no statistically significant difference in overall survival between the three groups.CONCLUSIONThe current study suggests that multifocality when compared to unifocal breast cancer carries additional prognostic information over traditional tumour characteristics.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"48 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731265","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}
Adam Boukind,Aviral C Sharma,Marco J Henriquez,Saif Badran
INTRODUCTIONGlucagon-like peptide-1 (GLP-1) receptor agonists have anti-inflammatory and immunomodulatory properties beyond glycemic control. Their impact on burn injury outcomes remains unexplored. This study assessed the potential impact of prior GLP-1 exposure on mortality, infectious complications, and critical care utilisation in burn patients.METHODSUsing the TriNetX US Network, adult patients with thermal burns ≤20% total body surface area (TBSA) between January 2018 and November 2025 were identified. Patients with GLP-1 documentation within one year before burn injury were propensity score matched with controls for age, sex, race, comorbidities, TBSA, body mass index (BMI), and hemoglobin A1c (HbA1c). Outcomes included 1-year mortality, infectious complications, critical care utilisation, and wound management outcomes. Sensitivity analyses examined 6-month and 3-year exposure windows.RESULTSAfter matching, 8,307 patients per cohort were included. GLP-1 exposure was associated with 54% reduced odds of mortality (odds ratio [OR] 0.46, p<0.001), 35% reduced intensive care unit admission (OR 0.65, p<0.001), and 62% reduced intubation (OR 0.38, p<0.001). Infectious complications were significantly decreased, including sepsis (32% reduction), pneumonia (24% reduction), and methicillin-resistant Staphylococcus aureus (MRSA) infections (27% reduction). The odds of broad-spectrum antibiotic use decreased 21%. Benefits persisted across all exposure windows. The 3-year cohort demonstrated a 27% increase in hypertrophic scarring (OR 1.27, p=0.031).CONCLUSIONPrior GLP-1 receptor agonist use was associated with a significant decrease in mortality, infectious complications, and critical care utilisation among burn patients, independent of metabolic factors like BMI. These findings warrant prospective studies to optimize perioperative management strategies in this patient population.
{"title":"Clinical Outcomes Associated with Prior GLP-1 Exposure in Burned Patients.","authors":"Adam Boukind,Aviral C Sharma,Marco J Henriquez,Saif Badran","doi":"10.1093/bjs/znag048","DOIUrl":"https://doi.org/10.1093/bjs/znag048","url":null,"abstract":"INTRODUCTIONGlucagon-like peptide-1 (GLP-1) receptor agonists have anti-inflammatory and immunomodulatory properties beyond glycemic control. Their impact on burn injury outcomes remains unexplored. This study assessed the potential impact of prior GLP-1 exposure on mortality, infectious complications, and critical care utilisation in burn patients.METHODSUsing the TriNetX US Network, adult patients with thermal burns ≤20% total body surface area (TBSA) between January 2018 and November 2025 were identified. Patients with GLP-1 documentation within one year before burn injury were propensity score matched with controls for age, sex, race, comorbidities, TBSA, body mass index (BMI), and hemoglobin A1c (HbA1c). Outcomes included 1-year mortality, infectious complications, critical care utilisation, and wound management outcomes. Sensitivity analyses examined 6-month and 3-year exposure windows.RESULTSAfter matching, 8,307 patients per cohort were included. GLP-1 exposure was associated with 54% reduced odds of mortality (odds ratio [OR] 0.46, p<0.001), 35% reduced intensive care unit admission (OR 0.65, p<0.001), and 62% reduced intubation (OR 0.38, p<0.001). Infectious complications were significantly decreased, including sepsis (32% reduction), pneumonia (24% reduction), and methicillin-resistant Staphylococcus aureus (MRSA) infections (27% reduction). The odds of broad-spectrum antibiotic use decreased 21%. Benefits persisted across all exposure windows. The 3-year cohort demonstrated a 27% increase in hypertrophic scarring (OR 1.27, p=0.031).CONCLUSIONPrior GLP-1 receptor agonist use was associated with a significant decrease in mortality, infectious complications, and critical care utilisation among burn patients, independent of metabolic factors like BMI. These findings warrant prospective studies to optimize perioperative management strategies in this patient population.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"67 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719526","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}
Francesco Saverio Papadia,Ottavio De Cian,Nicola Di Lorenzo,Ricardo Vitor Cohen
BACKGROUNDSurgical innovation often outpaces robust evaluation. This study used metabolic bariatric surgery (MBS), a field of high-intensity innovation, as a case study to evaluate reporting standards and ethical oversight for experimental procedures within surgery.METHODSWe conducted a systematic review in accordance with PRISMA 2020 guidelines. We searched PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, and Embase from January 2000 to December 2024 using terms related to metabolic bariatric surgery, surgical innovation, and non-standard intestinal bypass procedures. We included original studies reporting first-in-human or early clinical series of non-standard primary MBS involving significant intestinal modification, and excluded reviews, editorials, conference abstracts, revisional surgery, purely restrictive procedures, and device-based interventions. Two reviewers independently screened studies, extracted data on publication timing, patient numbers, follow-up, ethical approval, and trial registration, and assessed risk of bias using the Newcastle-Ottawa Scale, Joanna Briggs Institute checklist, and ROBINS-I tool.RESULTSFrom 57 included studies (10,754 patients), the median time from first human operation to publication was 5 years (IQR 3-8 years). The median initial cohort size was 39 patients (range 1-1074 patients). Institutional review board or ethical approval was reported in 47/57 studies (82%), while prospective clinical trial registration was documented in only 6/57 studies (11%). Methodological quality was low (mean Newcastle-Ottawa Scale score 5.0/9), with 56 of 57 studies judged at high risk of bias. Out of 57, studies, only 15 (26%) reported outcomes at ≥3 years, and 8 studies (14%) at ≥5 years.CONCLUSIONThis MBS case study reveals delayed publication and a widespread lack of prospective trial registration, exposing over 10,000 patients to experimental procedures outside a transparent research framework. These findings highlight a systemic failure in surgical innovation governance and underscore an urgent need for a cultural shift towards mandatory, prospective oversight frameworks to ensure patient safety and credible evidence generation.
背景：外科手术的创新常常超过可靠的评估。本研究以代谢减肥手术（MBS）这一高强度创新领域为例，评估手术实验过程的报告标准和伦理监督。方法按照PRISMA 2020指南进行系统评价。我们检索了2000年1月至2024年12月期间的PubMed/MEDLINE、Web of Science、Scopus、Cochrane Library和Embase，检索了与代谢减肥手术、外科创新和非标准肠旁路手术相关的术语。我们纳入了涉及重大肠道改变的非标准原发性MBS首次人体或早期临床系列的原始研究，排除了综述、社论、会议摘要、修正手术、纯限制性手术和基于设备的干预措施。两位审稿人独立筛选研究，提取发表时间、患者数量、随访、伦理批准和试验注册等数据，并使用纽卡斯尔-渥太华量表、乔安娜布里格斯研究所检查表和ROBINS-I工具评估偏倚风险。结果在纳入的57项研究（10754例患者）中，从首次人体手术到发表的中位时间为5年（IQR 3-8年）。初始队列中位数为39例（范围1-1074例）。47/57项研究（82%）报告了机构审查委员会或伦理批准，而前瞻性临床试验注册仅在6/57项研究（11%）中记录。方法学质量较低（纽卡斯尔-渥太华量表平均评分5.0/9），57项研究中有56项被判定为高偏倚风险。在57项研究中，只有15项（26%）报告了≥3年的结果，8项（14%）报告了≥5年的结果。本MBS案例研究揭示了延迟发表和普遍缺乏前瞻性试验注册，使10,000多名患者暴露在透明研究框架之外的实验程序中。这些发现强调了外科创新治理的系统性失败，并强调了迫切需要向强制性、前瞻性监督框架转变，以确保患者安全和可靠的证据生成。
{"title":"Navigating Uncharted Territory in Surgical Innovation: A systematic review of non-standard Metabolic Bariatric Surgery procedures.","authors":"Francesco Saverio Papadia,Ottavio De Cian,Nicola Di Lorenzo,Ricardo Vitor Cohen","doi":"10.1093/bjs/znag047","DOIUrl":"https://doi.org/10.1093/bjs/znag047","url":null,"abstract":"BACKGROUNDSurgical innovation often outpaces robust evaluation. This study used metabolic bariatric surgery (MBS), a field of high-intensity innovation, as a case study to evaluate reporting standards and ethical oversight for experimental procedures within surgery.METHODSWe conducted a systematic review in accordance with PRISMA 2020 guidelines. We searched PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, and Embase from January 2000 to December 2024 using terms related to metabolic bariatric surgery, surgical innovation, and non-standard intestinal bypass procedures. We included original studies reporting first-in-human or early clinical series of non-standard primary MBS involving significant intestinal modification, and excluded reviews, editorials, conference abstracts, revisional surgery, purely restrictive procedures, and device-based interventions. Two reviewers independently screened studies, extracted data on publication timing, patient numbers, follow-up, ethical approval, and trial registration, and assessed risk of bias using the Newcastle-Ottawa Scale, Joanna Briggs Institute checklist, and ROBINS-I tool.RESULTSFrom 57 included studies (10,754 patients), the median time from first human operation to publication was 5 years (IQR 3-8 years). The median initial cohort size was 39 patients (range 1-1074 patients). Institutional review board or ethical approval was reported in 47/57 studies (82%), while prospective clinical trial registration was documented in only 6/57 studies (11%). Methodological quality was low (mean Newcastle-Ottawa Scale score 5.0/9), with 56 of 57 studies judged at high risk of bias. Out of 57, studies, only 15 (26%) reported outcomes at ≥3 years, and 8 studies (14%) at ≥5 years.CONCLUSIONThis MBS case study reveals delayed publication and a widespread lack of prospective trial registration, exposing over 10,000 patients to experimental procedures outside a transparent research framework. These findings highlight a systemic failure in surgical innovation governance and underscore an urgent need for a cultural shift towards mandatory, prospective oversight frameworks to ensure patient safety and credible evidence generation.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"13 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695167","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}
Lissa Wullaert,Lotte van Leeuwen,Vanja de Weerd,Mai Van,Esther Oomen-de Hoop,Jaco Kraan,Maurice P H M Jansen,John W M Martens,Dirk J Grünhagen,Henk M W Verheul,Cornelis Verhoef,Saskia M Wilting
BACKGROUNDAlmost half of patients with colorectal liver metastases (CRLM) experience disease recurrence within one year after treatment with curative intent. To improve treatment, upfront identification of patients with CRLM at high risk of rapid disease recurrence is crucial.METHODSIn this retrospective cohort-study, pretreatment ctDNA levels were determined by the modified fast aneuploidy screening test-sequencing system (mFast-SeqS) in 182 patients with resectable CRLM who did not receive perioperative chemotherapy. Resulting aneuploidy scores were dichotomized using a predefined threshold and associated with clinical outcome.RESULTSOf 182 analysed patients, 34 (19%) were classified as ctDNA high and 156 (81%) as ctDNA low. Recurrence-free (RFS) and overall survival (OS) were shorter in the ctDNA high versus low group, with 1-year RFS of 29% versus 52%, and 3-year OS of 48% versus 78% respectively (log-rank P = 0.029 and < 0.001 respectively). The cumulative incidence of multiorgan recurrence within the first year after local treatment was significantly higher in ctDNA-high patients (Gray's test P < 0.001). Multivariable Cox regression analysis revealed that the aneuploidy score is independently associated with RFS (HR = 1.94; 95% c.i. 1.19 to 3.18) and multiorgan RFS up to 1 year (HR = 2.56; 95% c.i. 1.41 to 4.65) and OS up to 3 years (HR = 3.28; 95% c.i. 1.79 to 6.01).CONCLUSIONSThis study shows that mFast-SeqS provides an affordable and minimally invasive test for the upfront recognition of patients with CRLM at increased risk of rapid (multiorgan) disease recurrence.
{"title":"Presurgical levels of circulating tumour DNA in patients with resectable chemotherapy-naïve colorectal liver metastases: association with multiorgan recurrence and survival in the MIRACLE cohort.","authors":"Lissa Wullaert,Lotte van Leeuwen,Vanja de Weerd,Mai Van,Esther Oomen-de Hoop,Jaco Kraan,Maurice P H M Jansen,John W M Martens,Dirk J Grünhagen,Henk M W Verheul,Cornelis Verhoef,Saskia M Wilting","doi":"10.1093/bjs/znaf295","DOIUrl":"https://doi.org/10.1093/bjs/znaf295","url":null,"abstract":"BACKGROUNDAlmost half of patients with colorectal liver metastases (CRLM) experience disease recurrence within one year after treatment with curative intent. To improve treatment, upfront identification of patients with CRLM at high risk of rapid disease recurrence is crucial.METHODSIn this retrospective cohort-study, pretreatment ctDNA levels were determined by the modified fast aneuploidy screening test-sequencing system (mFast-SeqS) in 182 patients with resectable CRLM who did not receive perioperative chemotherapy. Resulting aneuploidy scores were dichotomized using a predefined threshold and associated with clinical outcome.RESULTSOf 182 analysed patients, 34 (19%) were classified as ctDNA high and 156 (81%) as ctDNA low. Recurrence-free (RFS) and overall survival (OS) were shorter in the ctDNA high versus low group, with 1-year RFS of 29% versus 52%, and 3-year OS of 48% versus 78% respectively (log-rank P = 0.029 and < 0.001 respectively). The cumulative incidence of multiorgan recurrence within the first year after local treatment was significantly higher in ctDNA-high patients (Gray's test P < 0.001). Multivariable Cox regression analysis revealed that the aneuploidy score is independently associated with RFS (HR = 1.94; 95% c.i. 1.19 to 3.18) and multiorgan RFS up to 1 year (HR = 2.56; 95% c.i. 1.41 to 4.65) and OS up to 3 years (HR = 3.28; 95% c.i. 1.79 to 6.01).CONCLUSIONSThis study shows that mFast-SeqS provides an affordable and minimally invasive test for the upfront recognition of patients with CRLM at increased risk of rapid (multiorgan) disease recurrence.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"51 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663818","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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