Best of upper GI and general surgery in 2024

The past year has seen important contributions to the fields of upper gastrointestinal and general surgery published in BJS Open, with findings that will influence clinical practice and future research. Here, I would like to point out five articles published in 2024, each thought-provoking and offering novel insights.

The retrospective cohort study by Knipper et al. examined survival outcomes of patients with oligometastatic oesophageal cancer undergoing different treatments¹. Traditionally managed with systemic therapies alone, metastatic oesophageal cancer has seen limited advancements in its treatment landscape. However, this study demonstrated that individualized multimodal approaches, including surgical resection, can offer significant survival benefits. Patients with limited metastatic disease treated with resection and adjunct therapies had median survival rates of 19 months, compared to just 11 months for those receiving chemotherapy alone. These findings challenge long-standing treatment paradigms and call for the integration of surgical options in selected oligometastatic cases, warranting further exploration through prospective trials.

Addressing an often-overlooked area of emergency general surgery, the scoping review on emergency umbilical hernia management by Walshaw et al. synthesized data from 14 studies encompassing over 50 000 patients². It revealed a lack of high-quality evidence guiding the emergency management of umbilical hernias. Key themes included surgical timing, repair methods (mesh versus suture; laparoscopic versus open), and outcomes such as morbidity and mortality rates. Although mesh repair showed promise in reducing recurrence, the lack of RCTs underlines the need for future robust studies.

The nationwide population-based study by Leijonmarck explored how surgeon age impacts patient outcomes following gastrectomy for gastric adenocarcinoma. The findings revealed a nuanced relationship: patients operated on by surgeons aged ≥47 years experienced marginally worse 5-year survival outcomes. However, this was potentially mediated by factors like lymph node yield and resection margin status³. These findings underline the importance of considering surgeon-related factors in patient outcomes and stimulated discussions about maintaining high standards in surgical care across all career stages⁴.

The multi-institutional retrospective analysis of Chao et al. compared outcomes of robot-assisted minimally invasive oesophagectomy (RAMIO) with conventional minimally invasive oesophagectomy for oesophageal squamous cell carcinoma⁵. The study demonstrated clear advantages of RAMIO, including reduced pneumonia rates, improved safety of recurrent laryngeal nerve dissection, and shorter hospital stays. Particularly notable was RAMIO’s efficacy in harvesting left recurrent laryngeal nerve lymph nodes, coupled with a significant reduction in nerve palsy rates. These findings position RAMIO as a superior surgical approach, especially for complex cases, and underscore the transformative potential of robotic technology in enhancing surgical outcomes.

Leveraging data from nearly 4000 patients of the ENSURE study, the analysis of Mantziari et al. explored sex-based disparities in outcomes following curative-intent oesophageal cancer treatment⁶. Female patients demonstrated significantly better long-term survival, particularly in adenocarcinoma, yet faced greater challenges with postoperative quality of life, including persistent gastrointestinal symptoms. In contrast, male patients reported better functional recovery but were more likely to encounter financial difficulties. These findings highlight the need for personalized postoperative care strategies and further research into the biological underpinnings of sex differences in cancer outcomes.

In summary, these five articles showcase the diversity and depth of surgical research published with BJS Open last year. I extend my gratitude to all the authors and reviewers I had the privilege of collaborating with over the past year and am looking forward to your next submissions to BJS Open!

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