Volume 8, Issue 3, June 2024

This systematic review and meta-analysis of 35 recent observational studies published between 1 January 2000 and 18 December 2023 including 909 077 patients demonstrated a survival advantage for women undergoing breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer compared with mastectomy. The pooled HR was 0.72 (95% c.i. 0.68 to 0.75, P < 0.001). Although these results should be interpreted with caution due to the low certainty of evidence, they should be shared with patients to support informed surgical decision-making.

Postoperative pancreatic fistulas remain the major complication after partial pancreatectomy. All RCTs investigating the potential benefits of artificial or autologous coverage after partial pancreatectomy were analysed. Coverage techniques as a whole, but especially performed in distal pancreatectomy and the application of autologous material, reduce the incidence of postoperative pancreatic fistulas and mitigate their postoperative burden.

There is a need to better understand the aetiology and pathogenesis of diverticular disease. Research suggests a genetic susceptibility of 40–50% in the formation of diverticular disease, supported by further genome-wide association studies. The aim of this review is to present the hypothesized functional effects of the identified gene loci.

Piperacillin/tazobactam as antimicrobial prophylaxis significantly lowers the risk of postoperative surgical-site infections, major surgical complications (complications classified as Clavien–Dindo grade greater than or equal to III), clinically relevant postoperative pancreatic fistulas (grades B and C), and mortality, hence supporting the implementation of piperacillin/tazobactam for surgical prophylaxis in current practice.

Umbilical hernias, although frequently asymptomatic, may become acutely symptomatic, strangulated or obstructed, and require emergency treatment. Robust evidence is required for high-quality care in this field. This scoping review demonstrates the paucity of high-quality data and a need for randomized trials addressing all aspects of emergency umbilical hernia repair, with patient-reported outcomes.

Neoadjuvant treatment for colon and rectal cancer continues to evolve. This comprehensive review summarizes the current guidance for neoadjuvant treatment and the promising avenues for future developments.

In recent decades, survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these "grown-ups" in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood, and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood.

This national study examines how resection margins of 0.0 mm, 0.1–0.9 mm and ≥1 mm influence overall survival in patients resected for colorectal liver metastasis in an era of modern perioperative chemotherapy, analysing data from the national registries SweLiv and SCRCR. Despite modern chemotherapy the resection margin is still an important factor for the survival of patients resected for colorectal liver metastasis, and a margin of ≥1 mm is needed to achieve the best possible outcome.

This is a large multicentric global study combining a number of large national peritoneal surface oncology databases from three continents (39 centres) for evaluating the use and choice of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasized colorectal cancer undergoing cytoreductive surgery. It is the largest study in the field of peritoneal surface oncology for colorectal cancer with crude survival analysis in over 2000 patients and propensity score matched survival analysis in over 1300 patients. This study found that oxaliplatin-based HIPEC resulted in superior overall and recurrence-free survival compared to mitomycin C-based HIPEC—a finding which persisted after propensity score matching. However, high-dose mitomycin C protocols resulted in improved survival, and a dose–response relationship between low-dose and high-dose HIPEC treatment regardless of protocol drug used was further discovered.

This observational cross-sectional multinational register-based study highlights differences in ambition to perform limited parathyroidectomy, as well as outcome, in Europe. The study's strength lies in its high volume of 99 participating clinics in 14 countries, and entails 9548 operations.

Infraingunial bypass surgery utilizing alternative vein grafts in octogenarians suffering from chronic limb-threatening ischaemia is safe and effective in terms of patency rates, limb salvage and survival compared with younger patients in the absence of the ipsilateral great saphenous vein. Age alone should not be a deterrent from performing bypass surgery.

In patients under 60 years old with acute DeBakey type 1 aortic dissection, when feasible, ascending aortic repair compared to total aortic arch repair is associated with favourable early and mid-term outcomes.

This multicentre, retrospective cohort study showed that with all three minimally invasive techniques (robot, transanal and laparoscopy) good oncological resection can be achieved in the treatment of MRI-defined low rectal cancer. However, patients treated in laparoscopic centres have an increased risk of a change in the preoperative intended procedure due to technical limitations.

Patients with any degree of clinical frailty have a significantly increased risk of developing postoperative complications, notably medical complications, such as pneumonia, atrial fibrillation, delirium, and sepsis, compared with patients without frailty. Furthermore, patients with clinical frailty have a significantly increased risk of short-term mortality compared with patients without frailty.

The aim of this study was to compare three minimally invasive surgical approaches for total mesorectal excision with primary anastomosis (laparoscopic total mesorectal excision, robotic total mesorectal excision, and transanal total mesorectal excision) using propensity score matching analysis. Newer minimally invasive approaches (robotic total mesorectal excision and transanal total mesorectal excision) demonstrated improved outcomes compared with laparoscopic total mesorectal excision.

This retrospective single-centre cohort study included 235 patients with metastasized oesophageal cancer. A comparison was conducted of patient outcomes after resection alone, multimodal therapy including surgery, chemotherapy alone, any other therapy without surgery, or best supportive care as a treatment for metastasized oesophageal cancer. Resection or multimodal therapy including surgery resulted in the best overall survival in the total cohort and in subcohorts of patients with metachronous solid-organ metastases, with metastases in the liver, lung, or adrenal gland, or with a single metastasis.

Two-hundred and ten young and 338 elderly stage III colon cancer patients treated with Japanese D3 lymphadenectomy were analysed. In young patients, positive central lymph nodes were more frequently observed and identified as a poor prognostic factor, compared with elderly patients. This suggests a different surgical approach can be considered according to patient age.

This is the first population-based cohort study investigating the association between preoperative use of ACEI, ARB and diuretics on postoperative dehydration and acute renal failure in Swedish rectal cancer patients operated with anterior resection and temporary ileostomy. A two- to three-fold risk of 90-day readmission was observed among exposed participants compared to unexposed, with the risk being most pronounced for ACEI users.

This prospective longitudinal observational study presents comprehensive data on health-related quality of life in patients with breast cancer. This study found that patients who had BCS or OPBS were more satisfied with their breasts and had a better body image after surgery compared with those that received mastectomy or mastectomy with immediate breast reconstruction.

We compared the outcomes of adults who underwent either LDLT or DDLT in the United States using propensity-score matching stratified by MELD score.

Our main finding was that recipients of LDLT with MELD scores exceeding 30 experienced significantly worse outcomes than DDLT recipients. Comparable patient survival was found between the two groups when patients underwent surgery with MELD scores ranging from 16 to 30.

For patients with MELD equal to or less than 15, LDLT was associated with better survival.

The risk of graft failure and the need for re-transplantation were significantly higher after LDLT across all the MELD strata.

This article discusses the ligation of intersphincteric fistula tract surgical technique for treating trans-sphincteric anal fistulas while preserving sphincter integrity. Despite its efficacy in short-term healing in the literature, the present study reveals below-standard primary healing rates and concerning levels of incontinence during long-term follow-up, emphasizing the need for a patient-centred approach and comprehensive prospective data collection by researchers and clinicians.

Comparing endoscopically and surgically resected T1 colon cancer, we found no significant differences in recurrence rates, even in cases classified as high-risk according to current guidelines. The only significant risk factor for cancer recurrence was lymphovascular invasion.

We are the first in Japan to conduct the multicentre prospective VITRUVIANO trial to evaluate the oncological utility of robotic surgery for advanced rectal cancer. In this article, we report the results of this analysis. In this trial, by setting stricter surgical qualifications compared with those of past clinical trials, we were able to control the quality of the surgery and, as a result, demonstrate favourable outcomes.

This study proved the power of soluble suppression of tumourigenicity 2 in predicting posthepatectomy liver failure in order to start early intervention.