bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis
Authors: Hobeika C , Cauchy F , Fuks D , Barbier L , Fabre J M , Boleslawski E , Regimbeau J M , Farges O , Pruvot F R , Pessaux P , Salamé E , Soubrane O , Vibert E , Scatton O ,   the AFC-LLR-2018 study group, Goumard C , Gayet B , Cherqui D , Nomi T , Oudafal N , Kawai T , Komatsu S , Okumura S , Petrucciani N , Laurent A , Bucur P , Trechot B , Nunèz J , Tedeschi M , Allard M.-A , Golse N , Ciacio O , Pittau G , Sa Cunha A , Adam R , Laurent C , Chiche L , Leourier P , Rebibo L , Ferre L , Souche F R , Chauvat J , Jehaes F , Mohkam K , Lesurtel M , Ducerf C , Mabrut J.-Y , Hor T , Paye F , Balladur P , Suc B , Muscari F , Millet G , El Amrani M , Ratajczak C , Lecolle K , Truant S , Kianmanesh A.-R , Codjia T , Schwarz L , Girard E , Abba J , Letoublon C , Chirica M , Carmelo A , VanBrugghe C , Cherkaoui Z , Unterteiner X , Memeo R , Buc E , Lermite E , Barbieux J , Bougard M , Marchese U , Ewald J , Turini O , Thobie A , Menahem B , Mulliri A , Lubrano J , Zemour J , Fagot H , Passot G , Gregoire E , Hardwigsen J , le Treut Y.-P , Patrice D
Published: January 2021

Background

The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND).

Methods

Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching.

Results

In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012).

Conclusion

The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
Parenchyma-sparing vessel-guided major hepatectomy: nonsense or new paradigm in liver surgery?
Authors: Torzilli G
Published: January 2021

Advanced liver surgery.
Reinforced versus standard stapler transection on postoperative pancreatic fistula in distal pancreatectomy: multicentre randomized clinical trial
Authors: Wennerblom J , Ateeb Z , Jönsson C , Björnsson B , Tingstedt B , Williamsson C , Sandström P , Ansorge C , Blomberg J , Del Chiaro M
Published: January 2021

Background

Postoperative pancreatic fistula is the leading cause of morbidity after distal pancreatectomy. Strategies investigated to reduce the incidence have been disappointing. Recent data showed a reduction in postoperative pancreatic fistula with the use of synthetic mesh reinforcement of the staple line.

Methods

An RCT was conducted between May 2014 and February 2016 at four tertiary referral centres in Sweden. Patients scheduled for distal pancreatectomy were eligible. Enrolled patients were randomized during surgery to stapler transection with biological reinforcement or standard stapler transection. Patients were blinded to the allocation. The primary endpoint was the development of any postoperative pancreatic fistula. Secondary endpoints included morbidity, mortality, and duration of hospital stay.

Results

Some 107 patients were randomized and 106 included in an intention-to-treat analysis (56 in reinforced stapling group, 50 in standard stapling group). No difference was demonstrated in terms of clinically relevant fistulas (grade B and C): 6 of 56 (11 per cent) with reinforced stapling versus 8 of 50 (16 per cent) with standard stapling (P = 0.332). There was no difference between groups in overall postoperative complications: 45 (80 per cent) and 39 (78 per cent) in reinforced and standard stapling groups respectively (P = 0.765). Duration of hospital stay was comparable: median 8 (range 2–35) and 9 (2–114) days respectively (P = 0.541).

Conclusion

Biodegradable stapler reinforcement at the transection line of the pancreas did not reduce postoperative pancreatic fistula compared with regular stapler transection in distal pancreatectomy. Registration number: NCT02149446 (http://www.clinicaltrials.gov).
The need to preserve surgical training
Authors: Masterton Gary
Published: January 2021

Surgical trainees have found their training opportunities disrupted throughout the COVID-19 pandemic. With an uncertain future and potential impeding second wave considerations should be made on how surgical training can be preserved.
Perioperative cell-free mutant KRAS dynamics in patients with pancreatic cancer
Authors: Hipp J , Hussung S , Timme-Bronsert S , Boerries M , Biesel E , Fichtner-Feigl S , Fritsch R , Wittel U A
Published: January 2021

This prospective observational biomarker trial evaluated the diagnostic and prognostic value of circulating KRAS mutations (cmKRAS) and their perioperative dynamics in patients with resectable pancreatic ductal adenocarcinoma (PDAC). Plasma cmKRAS samples (G12D, G12V, G12R, and G12C) were analysed by droplet digital PCR in 51 patients with resectable PDAC, 20 with advanced PDAC, and 34 with non-malignant pancreatic pathology. Preoperative detection of cmKRAS alone did not correlate with poorer overall and disease-free survival in this patient cohort. However, a perioperative change in cmKRAS, particularly accurate when an intraoperative sample was included, was identified as a new and useful marker for prediction of prolonged survival.

Promising biomarker
Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection
Authors: Ahmed S , Bonnett L , Melhuish A , Adil M T , Aggarwal I , Ali W , Bennett J , Boldock E , Burns F A , Czarniak E , Dennis R , Flower B , Fok R , Goodman A L , Halai S , Hanna T , Hashem M , Hodgson S H , Hughes G , Hurndall K-H , Hyland R , Iqbal M R , Jarchow-MacDonald A , Kailavasan M , Klimovskij M , Laliotis A , Lambourne J , Lawday S , Lee F , Lindsey B , Lund J N , Mabayoje D A , Malik K I , Muir A , Narula H S , Ofor U , Parsons H , Pavelle T , Prescott K , Rajgopal A , Roy I , Sagar J , Scarborough C , Shaikh S , Smart C J , Snape S , Tabaqchali M A , Tennakoon A , Tilley R , Vink E , White L , Burke D , Kirby A
Published: January 2021

Background

Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse.

Methods

A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further.

Results

Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was −0.19 (95 per cent c.i. −0.39 to −0.12) and − 0.01 (− 0.17 to −0.03) respectively.

Conclusion

Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.
Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis
Authors: Chua Darren , Syn Nicholas , Koh Ye-Xin , Goh Brian K P
Published: January 2021

Background

Minimally invasive hepatectomy (MIH) has become an important option for the treatment of various liver tumours. A major concern is the learning curve required. The aim of this study was to perform a systematic review and summarize current literature analysing the learning curve for MIH.

Methods

A systematic review of the literature pertaining to learning curves in MIH to July 2019 was performed using PubMed and Scopus databases. All original full-text articles published in English relating to learning curves for both laparoscopic liver resection (LLR), robotic liver resection (RLR), or a combination of these, were included. To explore quantitatively the learning curve for MIH, a meta-regression analysis was performed.

Results

Forty studies relating to learning curves in MIH were included. The median overall number of procedures required in studies utilizing cumulative summative (CUSUM) methodology for LLR was 50 (range 25–58) and for RLR was 25 (16–50). After adjustment for year of adoption of MIH, the CUSUM-derived caseload to surmount the learning curve for RLR was 47.1 (95 per cent c.i. 1.2 to 71.6) per cent; P = 0.046) less than that required for LLR. A year-on-year reduction in the number of procedures needed for MIH was observed, commencing at 48.3 cases in 1995 and decreasing to 23.8 cases in 2015.

Conclusion

The overall learning curve for MIH decreased steadily over time, and appeared less steep for RLR compared with LLR.
Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes
Authors: Morgan J L , Shrestha A , Reed M W R , Herbert E , Bradburn M , Walters S J , Martin C , Collins K , Ward S , Holmes G , Burton M , Lifford K , Edwards A , Ring A , Robinson T , Chater T , Pemberton K , Brennan A , Cheung K L , Todd A , Audisio R , Wright J , Simcock R , Thomson A M , Gosney M , Hatton M , Green T , Revill D , Gath J , Horgan K , Holcombe C , Winter M C , Naik J , Parmeschwar R , Wyld L
Published: January 2021

Background

Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy.

Methods

This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage.

Results

The study recruited 3416 women (median age 77 (range 69–102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains.

Conclusion

Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
Breast Angiosarcoma Surveillance Study: UK national audit of management and outcomes of angiosarcoma of the breast and chest wall
Authors: Banks J , George J , Potter S , Gardiner M D , Ives C , Shaaban A M , Singh J , Sherriff J , Hallissey M T , Horgan K , Harnett A , Desai A , Ferguson D J , Tillett R , Izadi D , Sadideen H , Jain A , Gerrand C , Holcombe C , Hayes A , Teoh V , Wyld L ,   the Breast Angiosarcoma Surveillance Study (BRASS) collaborative, Mallya R , Baker E , Asaad A , Wild B , Ali S , Emam Ahmed , Ayre G , Tsapralis N , Mowatt D , Wigginton H , Al-Himdani S , Knight H , MacInnes E , Scott L , Magdum A , Itte V , Fesatidou V , Winder A , Policastro T , Nanidis T , Konstantinos Tasoulis M , MacNeill F , Baghini F , Hamilton L , McGarry K , McIntosh S , Smith P , Ahmed M , Hallam K , Whisker L , Nadama H , Ashford R , Grundy C , Vella-Baldacchino M , Bond H , Kleidi E , Colfar J , Hardman C , Foster N , Lo S
Published: January 2021

Background

Breast angiosarcomas are rare tumours of vascular origin. Secondary angiosarcoma occurs following radiotherapy for breast cancer. Angiosarcomas have high recurrence and poor survival rates. This is concerning owing to the increasing use of adjuvant radiotherapy for the treatment of invasive breast cancer and ductal cancer in situ (DCIS), which could explain the rising incidence of angiosarcoma. Outcome data are limited and provide a poor evidence base for treatment. This paper presents a national, trainee-led, retrospective, multicentre study of a large angiosarcoma cohort.

Methods

Data for patients with a diagnosis of breast/chest wall angiosarcoma between 2000 and 2015 were collected retrospectively from 15 centres.

Results

The cohort included 183 patients with 34 primary and 149 secondary angiosarcomas. Median latency from breast cancer to secondary angiosarcoma was 6 years. Only 78.9 per cent of patients were discussed at a sarcoma multidisciplinary team meeting. Rates of recurrence were high with 14 of 28 (50 per cent ) recurrences in patients with primary and 80 of 124 (64.5 per cent ) in those with secondary angiosarcoma at 5 years. Many patients had multiple recurrences: total of 94 recurrences in 162 patients (58.0 per cent). Median survival was 5 (range 0–16) years for patients with primary and 5 (0–15) years for those with secondary angiosarcoma. Development of secondary angiosarcoma had a negative impact on predicted breast cancer survival, with a median 10-year PREDICT prognostic rate of 69.6 per cent, compared with 54.0 per cent in the observed cohort.

Conclusion

A detrimental impact of secondary angiosarcoma on breast cancer survival has been demonstrated. Although not statistically significant, almost all excess deaths were attributable to angiosarcoma. The increased use of adjuvant radiotherapy to treat low-risk breast cancer and DCIS is a cause for concern and warrants further study.
Long-term outcomes of lobectomy for papillary thyroid carcinoma with high-risk features
Authors: Xu S , Huang H , Wang X , Liu S , Xu Z , Liu J
Published: January 2021

Background

Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features.

Methods

Consecutive patients with PTC and at least one high-risk feature treated in 2000–2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis.

Results

Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P < 0.001). With a median follow-up of 93 months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1 : 1 case–control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784).

Conclusion

Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.
Faecal immunochemical testing in symptomatic patients to prioritize investigation: diagnostic accuracy from NICE FIT Study
Authors: D’Souza N , Delisle T Georgiou , Chen M , Benton S C , Abulafi M ,   the NICE FIT Steering Committee, Warren O , Ahmadi S , Parchment C , Shanmuganandan A , West N , Mitchell T , Sah S , Jackson N , Myers A , Ziprin P , Bloom I , Kaye S , Ramwell A , Jenkins J T , Monahan K
Published: January 2021

Background

This study investigated whether a quantitative faecal immunochemical test (FIT) could be used to select patients with either high- or low-risk symptoms of colorectal cancer for urgent investigation.

Methods

A double-blinded diagnostic accuracy study was conducted in 50 hospitals in England between October 2017 and December 2019. Patients were eligible for inclusion if they had been referred to secondary care with suspected colorectal cancer symptoms meeting national criteria for urgent referral and triaged to investigation with colonoscopy.

Results

The study included 9822 patients, of whom 7194 (73.2 per cent) had high-risk symptoms, 1994 (20.3 per cent) low-risk symptoms, and 634 (6.5 per cent) had other symptoms warranting urgent referral. In patients with high-risk symptoms, the sensitivity of FIT for colorectal cancer at cut-off values of 2 and 10 μg haemoglobin per g faeces was 97.7 (95 per cent c.i. 95.0 to 99.1) and 92.2 (88.2 to 95.2) per cent respectively, compared with 94.3 (84.3 to 98.8) and 86.8 (74.7 to 94.5) per cent in patients with low-risk symptoms at the same cut-off points. At cut-off values of 2, 10, and 150 μg/g, the positive predictive value for colorectal cancer was 8.9, 16.2, and 30.5 per cent respectively for those with high-risk symptoms, and 8.4, 16.9, and 35.5 per cent for those with low-risk symptoms.

Conclusion

FIT safely selects patients with high or low risk symptoms of colorectal cancer for investigation.
Indocyanine green fluorescence angiographyversusstandard intraoperative methods for prevention of anastomotic leak in colorectal surgery: meta-analysis
Authors: Trastulli S , Munzi G , Desiderio J , Cirocchi R , Rossi M , Parisi A
Published: January 2021

Background

Assessment of anastomotic blood perfusion with intraoperative indocyanine green fluorescence angiography (ICG-FA) may be effective in preventing anastomotic leak compared with standard intraoperative methods in colorectal surgery.

Methods

MEDLINE, PubMed, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for RCTs and observational studies on intraoperative ICG-FA to May 2020. Odds ratios (ORs), risk differences and mean differences (MDs) were calculated with 95 per cent c.i. based on intention-to-treat analysis. The number needed to treat for an additional beneficial outcome was also estimated.

Results

Twenty-five comparative studies included a total of 7735 patients. The use of intraoperative ICG fluorescence angiography was linked with a significant reduction in all grades anastomotic leak (OR 0.39 (95 per cent c.i. 0.31 to 0.49), P < 0.001; number needed to treat for an additional beneficial outcome (NNTB) 23) and length of hospital stay (MD −0.72 (95 per cent c.i. −1.22 to −0.21) days, P = 0.006). A significantly lower incidence of grade A (OR 0.33 (0.18 to 0.60), P < 0.001), grade B (OR 0.58 (0.35 to 0.97), P = 0.04) and grade C (OR 0.59 (0.38 to 0.92), P = 0.02) anastomotic leak was demonstrated in favour of ICG-FA. For low or ultra-low rectal resection, the odds of developing anastomotic leakage was 0.32 (0.23 to 0.45) (P < 0.001; NNTB 14). There were no differences in duration of surgery, and no adverse events related to ICG fluorescent injection.

Conclusion

The use of ICG-FA instead of standard intraoperative methods to assess anastomosis blood perfusion in colorectal surgery leads to a significant reduction in anastomotic leakage and in the need for surgical reintervention for anastomotic leak, especially in patients with low or ultra-low rectal resections.
Sporadic non-functioning pancreatic neuroendocrine tumours: multicentre analysis
Authors: Ricci C , Partelli S , Landoni L , Rinzivillo M , Ingaldi C , Andreasi V , Nessi C , Muffatti F , Fontana M , Tamburrino D , Deiro G , Alberici L , Campana D , Panzuto F , Bassi C , Falconi M , Casadei R
Published: January 2021

Background

Outcomes after surgery for sporadic pancreatic neuroendocrine neoplasms (Pan-NENs) were evaluated.

Methods

This multicentre study included patients who underwent radical pancreatic resection for sporadic non-functioning Pan-NENs. In survival analysis, the risk of mortality in this cohort was analysed in relation to that of the matched healthy Italian population. Relative survival (RS) was calculated as the rate between observed and expected survival. Factors related to RS were investigated using multivariable modelling.

Results

Among 964 patients who had pancreatic resection for sporadic non-functioning Pan-NENs, the overall RS rate was 91.8 (95 per cent c.i. 81.5 to 96.5) per cent. 2019 WHO grade (hazard ratio (HR) 5.75 (s.e. 4.63); P = 0.030) and European Neuroendocrine Tumour Society (ENETS) TNM stage (6.73 (3.61); P < 0.001) were independent predictors of RS. The probability of a normal lifespan for patients with G1, G2, G3 Pan-NENS, and pancreatic neuroendocrine carcinomas (Pan-NECs) was 96.7, 54.8, 0, and 0 per cent respectively. The probability of a normal lifespan was 99.8, 99.3, 79.8, and 46.8 per cent for those with stage I, II, III, and IV disease respectively. The overall disease-free RS rate was 73.6 (65.2 to 79.5) per cent. 2019 WHO grade (HR 2.10 (0.19); P < 0.001) and ENETS TNM stage (HR 2.50 (0.24); P < 0.001) significantly influenced disease-free RS. The probability of disease-free survival was 93.2, 84.9, 45.2, and 6.8 per cent for patients with stage I, II, III, and IV disease, and 91.9, 45.2, 9.4, and 0.7 per cent for those with G1, G2, G3 Pan-NENS, and Pan-NECs, respectively.

Conclusion

A surgical approach seems without benefit for Pan-NECs, and unnecessary for small G1 sporadic Pan-NENs. Surgery alone may be insufficient for stage III–IV and G3 Pan-NENs.
Factors influencing local and distant recurrence following resection of periampullary cancer
Authors: Bhandare M S , Mondal A , Chaudhari V , Bal M , Yadav S , Ramaswamy A , Ostwal V , Shetty N , Shrikhande S V
Published: January 2021

Background

Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences.

Methods

This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed.

Results

Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM.

Conclusion

Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.
Use of transanal drainage tube to prevent anastomotic leakage: intangible differences between the East and the West
Authors: Wu Z , Wang Q , Li Z , Ji J
Published: January 2021

Trans-anal drainage tube is used to reduce the rectal pressure, especially at the anastomotic site and thus to protect the anastomosis. Ideally it serves as and even may replace a diverting stoma. When compared to no treatment, the effectiveness of TDT seems confirmed based on the literature, but it remains uncertain whether TDT can replace the diverting stoma. Despite the insignificant tangible costs of TDT, it seems different cultures put varied weight on the intangible costs such as discomfort and pain to patients after surgery.
Centralized repeated resectability assessment of patients with colorectal liver metastases during first-line treatment: prospective study
Authors: Isoniemi H , Uutela A , Nordin A , Lantto E , Kellokumpu I , Ovissi A , Kosunen J , Kallio R , Soveri L M , Salminen T , Ålgars A , Lamminmäki A , Halonen P , Ristamäki R , Räsänen J , Karjula H , Vaalavuo Y , Lavonius M , Osterlund P
Published: January 2021

Background

Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases.

Methods

The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival.

Results

Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0–1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0–1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively.

Conclusion

Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.
Effect of centralization and regionalization of pancreatic surgery on resection rates and survival
Authors: Latenstein A E J , Mackay T M , van der Geest L G M , van Eijck C H J , de Meijer V E , Stommel M W J , Vissers P A J , Besselink M G , de Hingh I H J T ,   the Dutch Pancreatic Cancer Group
Published: January 2021

Background

Centralization of pancreatic surgery in the Netherlands has been ongoing since 2011. The aim of this study was to assess how centralization has affected the likelihood of resection and survival of patients with non-metastatic pancreatic head and periampullary cancer, diagnosed in hospitals with and without pancreatic surgery services.

Methods

An observational cohort study was performed on nationwide data from the Netherlands Cancer Registry (2009–2017), including patients diagnosed with non-metastatic pancreatic head or periampullary cancer. The period of diagnosis was divided into three time intervals: 2009–2011, 2012–2014 and 2015–2017. Hospital of diagnosis was classified as a pancreatic or non-pancreatic surgery centre. Analyses were performed using multivariable logistic and Cox regression models.

Results

In total, 10 079 patients were included, of whom 3114 (30.9 per cent) were diagnosed in pancreatic surgery centres. Between 2009–2011 and 2015–2017, the number of patients undergoing resection increased from 1267 of 3169 (40.0 per cent) to 1705 of 3566 (47.8 per cent) (P for trend < 0.001). In multivariable analysis, in 2015–2017, unlike the previous periods, patients diagnosed in pancreatic and non-pancreatic surgery centres had a similar likelihood of resection (odds ratio 1.08, 95 per cent c.i. 0.90 to 1.28; P = 0.422). In this period, however, overall survival was higher in patients diagnosed in pancreatic surgery than in those diagnosed in non-pancreatic surgery centres (hazard ratio 0.92, 95 per cent c.i. 0.85 to 0.99; P = 0.047).

Conclusion

After centralization of pancreatic surgery, the resection rate for patients with pancreatic head and periampullary cancer diagnosed in non-pancreatic surgery centres increased and became similar to that in pancreatic surgery centres. Overall survival remained higher in patients diagnosed in pancreatic surgery centres.
Comprehensive classification of anatomical variants of the main biliary ducts
Authors: Janssen B V , van Laarhoven S , Elshaer M , Cai H , Praseedom R , Wang T , Liau S -S
Published: January 2021

This systematic review provides the most comprehensive overview of intrahepatic biliary anatomical variants to date. Additionally, it proposes a clinically focused, prevalence-based classification system based on meta-analysis of a large pooled dataset whilst incorporating the merits of previous classification systems.
Epidemic prevention and control in the operating room during the COVID-19 pandemic
Authors: Zhang S , Xu X , Wang H
Published: January 2021

How to regular epidemic prevent and control of operating room during COVID-19 pandemics,active and effective measures of regular epidemic prevention and control of the operating room should be attached great importance to prevent spreading the virus.
Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis
Authors: Heil J , Korenblik R , Heid F , Bechstein W O , Bemelmans M , Binkert C , Björnsson B , Breitenstein S , Detry O , Dili A , Dondelinger R F , Gerard L , Giménez-Maurel T , Guiu B , Heise D , Hertl M , Kalil J A , Klein J J , Lakoma A , Neumann U P , Olij B , Pappas S G , Sandström P , Schnitzbauer A , Serrablo A , Tasse J , Van der Leij C , Metrakos P , Van Dam R , Schadde E
Published: January 2021

Background

The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.

Methods

All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016–2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan–Meier analysis.

Results

In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders.

Conclusion

PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
Selective impact of COVID-19 in patients presenting with non-specific abdominal pain
Authors: Alsaoudi T , Slavin D , Khasawneh F , Chung W Y , Eltweri A , Sahloul M , Bhardwaj N , Malde D , Dennison A R , Garcea G
Published: January 2021

The effect of COVID on surgical admissions was investigated by comparing such admissions from March to August 2020 with those in the same period in 2019. A significant reduction was noted in surgical admissions. The majority of this reduction was seen in the group with non-specific abdominal pain. It is presumed that public adherence to authorities’ message and effective ambulatory care are behind this decrease.

we investigated the COVID effect on surgical admissions by comparing surgical admissions to the same period in 2019. significant reduction was noted of surgical admissions. interestingly, the majority of this reduction was seen in the non specific abdominal pain group. it is presumed that public adherence to authorities message and effective ambulatory care are behind this decrease.
Oncological outcomes of laparoscopic versus open rectal cancer resections: meta-analysis of randomized clinical trials
Authors: Creavin B , Kelly M E , Ryan É J , Ryan O K , Winter D C
Published: January 2021

Background

The role of laparoscopic rectal cancer surgery has been questioned owing to conflicting reports on pathological outcomes from recent RCTs. However, it is unclear whether these pathological markers and the surgical approach have an impact on oncological outcomes. This study assessed oncological outcomes of laparoscopic and open rectal cancer resections.

Methods

A meta-analysis of RCTs was performed. Primary endpoints included oncological outcomes (disease-free survival (DFS), overall survival (OS), local recurrence). Secondary endpoints included surrogate markers for the quality of surgical resection.

Results

Twelve RCTs including 3744 patients (2133 laparoscopic, 1611 open) were included. There was no significant difference in OS (hazard ratio (HR) 0.87, 95 per cent c.i. 0.73 to 1.04; P = 0.12; I2 = 0 per cent) and DFS (HR 0.95, 0.81 to 1.11; P = 0.52; I2 = 0 per cent) between laparoscopic and open rectal resections. There was no significant difference in locoregional (odds ratio (OR) 1.03, 95 per cent c.i. 0.72 to 1.48; P = 0.86; I2 = 0 per cent) or distant (OR 0.87, 0.70 to 1.08; P = 0.20; I2 = 7 per cent) recurrence between the groups. Achieving a successful composite score (intact mesorectal excision, clear circumferential resection margin and distal margin) was significantly associated with improved DFS (OR 0.55, 0.33 to 0.74; P < 0.001; I2 = 0 per cent). An intact or acceptable mesorectal excision (intact mesorectal excision with or without superficial defects) had no impact on DFS. Finally, a positive CRM was associated with worse DFS.

Conclusion

Well performed surgery (laparoscopic or open) achieves excellent oncological outcomes with very little difference between the two modalities. The advantage and benefit of minimally invasive surgery should be assessed on an individual basis.
Comment on: Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer
Authors: Hu Qiang , Sun Yuanshui , Yang Xiyin
Published: January 2021

We have read with interest the article published by Kamarajah S K,et al1. Although we believe it is a very interesting topic, we would like to offer the following points for your consideration.
Shifting paradigms in two common abdominal surgical emergencies during the pandemic
Authors: Selvaggi L , Menegon Tasselli F , Sciaudone G , Kontovounisios C , Cosenza A , Sica G S , Selvaggi F , Pellino G
Published: January 2021

During the pandemic there was a reduction in access to the hospital and surgical treatment of appendicitis and cholecystitis at a global level. Some strategies adopted during this challenging time could be applied even after the emergency has been controlled.
Undergraduate surgical education during COVID-19: could augmented reality provide a solution?
Authors: Luck J , Gosling N , Saour S
Published: January 2021

The COVID-19 pandemic has significantly disrupted undergraduate medical education. In this original research letter, we describe how remote, augmented reality-enhanced teaching sessions can be successfully delivered at a time when the provision of surgical education is particularly challenging.
Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer
Authors: Wright C M , Moorin R E , Saunders C , Marinovich M L , Taylor D B ,   the ROLLIS study group, Bourke A G , Westcott E J , Chong C Y L , Liang R , Hughes R L , Elder E
Published: January 2021

Background

The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery.

Methods

This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62).

Results

The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted.

Conclusion

Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.
Author response to: Clean Cut (adaptive, multimodal surgical infection prevention programme) for low-resource settings: a prospective quality improvement study
Authors: Forrester Jared A , Starr Nichole , Gebeyehu Natnael , Negussie Tihitena , Weiser Thomas G
Published: January 2021

response to commentary
Raised serum amylase in patients with COVID-19 may not be associated with pancreatitis
Authors: Stephens J R , Wong J L C , Broomhead R , Stümpfle R , Waheed U , Patel P , Brett S J , Soni S
Published: January 2021

A high incidence of pancreatitis in COVID-19 has been reported. Although a high proportion of critically unwell patients with COVID-19 have raised serum amylase levels, this does not necessarily reflect acute pancreatitis or a clinically important pancreatic injury.
Double prevalence of appendicular peritonitis during COVID times
Authors: Riveros S , Artigas G , Inzunza M , Rebolledo R , Brañes A , Crovari F , Achurra P
Published: January 2021

International recommendations during the COVID-19 change favoring medical management and open surgical approach of acute appendicitis.

During COVID times, the presence of appendicular peritonitis was doubled.

The collateral damage of the COVID pandemic has not yet been fully evaluated.
Impact of enhanced personal protective equipment on surgeon workload and intraoperative patient outcomes
Authors: Gysling S , Maresca G , Brooks A , Patel A , Caruana E J
Published: January 2021

This work shows the need for targeted improvement to mitigate communication challenges associated with use of enhanced personal protective equipment. The data provide reassurance to surgeons and patients that there is no negative impact on surgeon workload or patient outcomes from use of enhanced personal protective equipment in the operating theatre.
Clinicopathological profile of colorectal cancer at a tertiary hospital in Kenya
Authors: Abdulkarim A , Barasa M
Published: January 2021

Haematochezia was the commonest presenting feature while rectum was the predominant anatomical site involved. Since these clinical features overlap with those associated with commoner benign anorectal condition like haemorrhoids, there is need to raise awareness and stimulate high index of clinical suspicion for malignancy in order to reduce delay in diagnosis and intervention especially in our setting where we noted younger patients presenting with advanced disease.
Locoregional recurrence after transanal total mesorectal excision: an emotional rollercoaster
Authors: Pena R , Borja de Lacy F , Balibrea J M , Lacy A M
Published: January 2021

Transanal total mesorectal excision is a complex technique that should be performed in expert centers.
Initiating Antiretroviral Treatment Early in Infancy Has Long-term Benefits on the Human Immunodeficiency Virus Reservoir in Late Childhood and Adolescence
Authors: Avettand-Fenoel Véronique , Lechenadec Jérôme , Diallo Mariama Sadjo , Fillion Marine , Melard Adeline , Samri Assia , Dollfus Catherine , Blanche Stéphane , Faye Albert , Amokrane Kahina , Autran Brigitte , Buseyne Florence , Warszawski Josiane , Frange Pierre ,   ANRS-EP59-CLEAC Study Group, Courcoux Mary-France , Dollfus Catherine , Tabone Marie-Dominique , Vaudre Geneviève , Fourcade Corinne , Warsazawski Josiane , Lechenadec Jérôme , Dialla Olivia , Nailler Laura , Selmi Lamya Ait Si , Leymarie Isabelle , Wack Thierry , Hoctin Alexandre , Feraon-Nanache Razika , Hau Isabelle , Gakobwa Cécile , Avettand-Fenoël Véronique , Blanche Stéphane , Fillion Marine , Frange Pierre , Mahlaoui Nizar , Mélard Adeline , Veber Florence , Mourey Marie-Christine , Marcou Valérie , Faye Albert , Lévine Martine , Richard Sandrine , Autran Brigitte , Samri Assia , Diallo Mariama , Caillat-Zucman Sophie , Amokrane Kahina , Ivanova-Derin Rayna , Chacé Anne , Buseyne Florence , Montange Thomas , Batalie Damien , Fert Ingrid , Saez-Cirion Asier , Monceaux Valérie , Scott-Algara Daniel , Marchand Lucie , Lebrasseur Delphine , Levier Axel
Published: January 2021

Background

Early combined antiretroviral therapy (cART) limits the total HIV-DNA load in children. However, data on its impact in older children and adolescents remain scarce. This study compares HIV reservoirs in children (5–12 years) and adolescents (13–17 years) who started cART <6 months (early [E-] group) or >2 years (late [L-] group).

Methods

The ANRS-EP59-CLEAC study prospectively enrolled 76 patients perinatally infected with HIV-1 who reached HIV-RNA <400 copies/mL <24 months after cART initiation, regardless of subsequent viral suppression (E-group: 27 children, 9 adolescents; L-group: 19 children, 21 adolescents). Total and integrated HIV-DNA were quantified in blood and in CD4+ T-cell subsets. A substudy assessed HIV reservoir inducibility after ex vivo peripheral blood mononuclear cell (PBMC) stimulation.

Results

Total HIV-DNA levels were lower in early- versus late-treated patients (children: 2.14 vs 2.87 log copies/million PBMCs; adolescents: 2.25 vs 2.74 log; P < .0001 for both). Low reservoir was independently associated with treatment precocity, protective HLA, and low cumulative viremia since cART initiation. The 60 participants with undetectable integrated HIV-DNA started cART earlier than other patients (4 vs 54 months; P = .03). In those with sustained virological control, transitional and effector memory CD4+ T cells were less infected in the E-group than in the L-group (P = .03 and .02, respectively). Viral inducibility of reservoir cells after normalization to HIV-DNA levels was similar between groups.

Conclusions

Early cART results in a smaller blood HIV reservoir until adolescence, but all tested participants had an inducible reservoir. This deserves cautious consideration for HIV remission strategies.