bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database
Authors: Abdelhamid A , Aspinall S 
Published: January 2021

Abstract

Background
Intraoperative nerve monitoring (IONM) is used increasingly in thyroid surgery to prevent recurrent laryngeal nerve (RLN) injury, despite lack of definitive evidence. This study analysed the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to investigate whether IONM reduced the incidence of RLN injury.

Methods
UKRETS data were extracted on 28 July 2018. Factors related to risk of RLN palsy, such as age, sex, retrosternal goitre, reoperation, use of energy devices, extent of surgery, nodal dissection and IONM, were analysed. Data with missing entries for these risk factors were excluded. Outcomes of patients who had preoperative and postoperative laryngoscopy were analysed.

Results
RLN palsy occurred in 4.9 per cent of thyroidectomies. The palsy was temporary in 64.6 per cent and persistent in 35.4 per cent of patients. In multivariable analysis, IONM reduced the risk of RLN palsy (odds ratio (OR) 0.63, 95 per cent confidence interval (CI) 0.54 to 0.74, P &lt; 0.001) and persistent nerve palsy (OR 0.47, 0.37 to 0.61, P &lt; 0.001). Outpatient laryngoscopy was also associated with a reduced incidence of RLN palsy (OR 0.50, 0.37 to 0.67, P &lt; 0.001). Bilateral RLN palsy occurred in 0.3 per cent. Reoperation (OR 12.30, 2.90 to 52.10, P = 0.001) and total thyroidectomy (OR 6.52, 1.50 to 27.80; P = 0.010) were significantly associated with bilateral RLN palsy.

Conclusion
The use of IONM is associated with a decreased risk of RLN injury in thyroidectomy. These results based on analysis of UKRETS data support the routine use of RLN monitoring in thyroid surgery.
Patient engagement study to identify and improve surgical experience
Authors: Kennedy E D , McKenzie M , Schmocker S , Jeffs L , Cusimano M D , Pooni A , Nenshi R , Scheer A S , Forbes T L , McLeod R S 
Published: January 2021

Abstract

Background
Patient engagement is the establishment of active partnerships between patients, families, and health professionals to improve healthcare delivery. The objective of this project was to conduct a series of patient engagement workshops to identify areas to improve the surgical experience and develop strategies to address areas identified as high priority.

Methods
Faculty surgeons and patients were invited to participate in three in-person meetings. Evaluation included identifying and developing strategies for three priority areas to improve the surgical experience and level of engagement achieved at each meeting.

Results
Sixteen faculty surgeons and 32 patients participated. Some 63 themes to improve the surgical experience were identified; the three highest-priority themes were physician communication, discharge process, and expectations at home after discharge. Individual improvement strategies for these three prioritized themes (12, 36 and 6 respectively) were used to develop a formal strategic plan, and included a physician communication survey, discharge process worksheet and video, and guideline regarding what to expect at home after discharge. Overall, the level of engagement achieved was considered high by over 85 per cent of the participants.

Conclusion
A high level of patient engagement was achieved. Priorities were identified with patients and surgeons to improve surgical experience, and strategies were developed to address these areas.
Nationwide study of surgery for primary infected abdominal aortic and common iliac artery aneurysms
Authors: Hosaka A , Kumamaru H , Takahashi A , Azuma N , Obara H , Miyata T , Obitsu Y , Zempo N , Miyata H , Komori K ,   the Japanese Society for Vascular Surgery Database Management Committee, Zempo N , Azuma N , Obitsu Y , Shigematsu K , Inoue Y , Okazaki J , Obara H , Satokawa H , Sugimoto I , Banno H , Fujimura N , Hosaka A , Mii S , Morikage N , Yamaoka T 
Published: January 2021

Abstract

Background
Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined.

Methods
A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).

Results
Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P &lt; 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).

Conclusion
In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial)
Authors: Treskes K , Sierink J C , Edwards M J R , Beuker B J A , Van Lieshout E M M , Hohmann J , Saltzherr T P , Hollmann M W , Van Dieren S , Goslings J C , Dijkgraaf M G W ,   REACT-2 study group, Luitse J S , Schepers T , Beenen L F M , Tromp T N , Brink M , El Moumni M , Harbers J S , Patka P , den Hartog D , Hagenaars T 
Published: January 2021

Abstract

Background
The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation.

Methods
In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive.

Results
A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were €25 809 (95 per cent bias-corrected and accelerated (bca) c.i. €22 617 to €29 137) for the iTBCT group and €26 155 (€23 050 to €29 344) for the STWU group, a difference per patient in favour of iTBCT of €346 (€4987 to €4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference −5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8–0.9) and in those with traumatic brain injury (more than 0.9).

Conclusion
Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.
Transanal mesorectal excision: early outcomes in Australia and New Zealand
Authors: Lau S , Kong J , Bell S , Heriot A , Stevenson A , Moloney J , Hayes J , Merrie A , Eglinton T , Guest G , Clark D , Warrier S 
Published: January 2021

Abstract

Background
Transanal total mesorectal excision (taTME) aims to overcome some of the technical challenges faced when operating on mid and low rectal cancers. Specimen quality has been confirmed previously, but recent concerns have been raised about oncological safety. This multicentre prospective study aimed to evaluate the safety of taTME among early adopters in Australia and New Zealand.

Methods
Data from all consecutive patients who had taTME for rectal cancer from July 2014 to February 2020 at six tertiary referral centres in Australasia were recorded and analysed.

Results
A total of 308 patients of median age of 64 years underwent taTME. Some 75.6 per cent of patients were men, and the median BMI was 26.8 kg/m2. The median distance of tumour from anal verge was 7 cm. Neoadjuvant chemoradiotherapy was administered to 57.8 per cent of patients. The anastomotic leak rate was 8.1 per cent and there was no mortality within 30 days of surgery. Pathological examination found a complete mesorectum in 295 patients (95.8 per cent), a near-complete mesorectum in seven patients (2.3 per cent), and an incomplete mesorectum in six patients (1.9 per cent). The circumferential resection margin and distal resection margin was involved in nine patients (2.9 per cent), and two patients (0.6 per cent) respectively. Over a median follow-up of 22 months, the local recurrence rate was 1.9 per cent and median time to local recurrence was 30.5 months.

Conclusion
This study showed that, with appropriate training and supervision, skilled minimally invasive rectal cancer surgeons can perform taTME with similar pathological and oncological results to open and laparoscopic surgery.
Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial
Authors: Attaallah Wafi 
Published: January 2021

I read the article ‘Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial’ by C. Maulat et al. (1) with great interest.
I wanted to draw attention to certain details. The authors supposed that the use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. However I think that this conclusion has some pitfalls which should be unadertaken to consideration.
Interventions for great saphenous vein reflux: network meta-analysis of randomized clinical trials
Authors: Siribumrungwong B , Wilasrusmee C , Orrapin S , Srikuea K , Benyakorn T , McKay G , Attia J , Rerkasem K , Thakkinstian A 
Published: January 2021

Abstract

Background
A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent.

Methods
A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- and long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates.

Results
Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons.

Conclusion
Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.
Systematic review on reporting of components and outcomes in randomized clinical trials of paraoesophageal hernia mesh repair
Authors: Currie A C , Penney N , Kamocka A , Singh P , Abbassi-Ghadi N , Preston S R 
Published: January 2021

Abstract

Background
Surgical interventions, such as paraoesophageal hernia (POH) repair, are complex with multiple components that require consideration in the reporting of clinical trials. Many aspects of POH repair, including mesh hiatal reinforcement and fundoplication type, are contentious. This review summarizes the reporting of components and outcomes in RCTs of POH repair.

Methods
Systematic searches identified RCTs of POH repair published from 1995 to 2020. The patient selection criteria for RCT involvement were noted. The components of the surgical interventions in these RCTs were recorded using the CONSORT guidelines for non-pharmacological treatments, Template for Intervention Description and Replication (TIDieR) and Blencowe frameworks. The outcomes were summarized and definitions sought for critical variables, including recurrence.

Results
Of 1918 abstracts and 21 screened full-text articles, 12 full papers reporting on six RCTs were included in the review. The patient selection criteria and definitions of POH between trials varied considerably. Although some description of trial interventions was provided in all RCTs, this varied in depth and detail. Four RCTs described efforts to standardize the trial intervention. Outcomes were reported inconsistently, were rarely defined fully, and overall trial conclusions varied during follow-up.

Conclusion
This lack of detail on the surgical intervention in POH repair RCTs prevents full understanding of what exact procedure was evaluated and how it should be delivered in clinical practice to gain the desired treatment effects. Improved focus on the definitions, descriptions and reporting of surgical interventions in POH repair is required for better future RCTs.
Prognostic grade for resecting hepatocellular carcinoma: multicentre retrospective study
Authors: Takayama T , Yamazaki S , Matsuyama Y , Midorikawa Y , Shiina S , Izumi N , Hasegawa K , Kokudo N , Sakamoto M , Kubo S , Kudo M , Murakami T , Nakashima O ,   the Liver Cancer Study Group of Japan
Published: January 2021

Abstract

Background
Surgical treatment for hepatocellular carcinoma (HCC) is advancing, but a robust prediction model for survival after resection is not available. The aim of this study was to propose a prognostic grading system for resection of HCC.

Methods
This was a retrospective, multicentre study of patients who underwent first resection of HCC with curative intent between 2000 and 2007. Patients were divided randomly by a cross-validation method into training and validation sets. Prognostic factors were identified using a Cox proportional hazards model. The predictive model was built by decision-tree analysis to define the resection grades, and subsequently validated.

Results
A total of 16 931 patients from 795 hospitals were included. In the training set (8465 patients), four surgical grades were classified based on prognosis: grade A1 (1236 patients, 14.6 per cent; single tumour 3 cm or smaller and anatomical R0 resection); grade A2 (3614, 42.7 per cent; single tumour larger than 3 cm, or non-anatomical R0 resection); grade B (2277, 26.9 per cent; multiple tumours, or vascular invasion, and R0 resection); and grade C (1338, 15.8 per cent; multiple tumours with vascular invasion and R0 resection, or R1 resection). Five-year survival rates were 73.9 per cent (hazard ratio (HR) 1.00), 64.7 per cent (HR 1.51, 95 per cent c.i. 1.29 to 1.78), 50.6 per cent (HR 2.53, 2.15 to 2.98), and 34.8 per cent (HR 4.60, 3.90 to 5.42) for grades A1, A2, B, and C respectively. In the validation set (8466 patients), the grades had equivalent reproducibility for both overall and recurrence-free survival (all P &lt; 0.001).

Conclusion
This grade is used to predict prognosis of patients undergoing resection of HCC.
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

Abstract

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.
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

Abstract

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).
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