Volume 8, Issue 4, August 2024

Frailty is significantly correlated with short- and long-term mortality rates following emergency laparotomy, as well as an adverse morbidity rate and functional outcomes. Identifying frailty using the Clinical Frailty Scale may aid in patient-centred decision-making and implementation of tailored care strategies for these ‘high-risk’ patients, with the aim of reducing adverse outcomes following emergency laparotomy.

This was a pilot RCT investigating the effect of remote ischaemic preconditioning in patients undergoing subacute laparoscopic cholecystectomy on gene expression (>500 genes) and upstream circulating immunological cytokines and vascular trauma–associated proteins up to 24 h after surgery. The study did not demonstrate significant differences on outcomes between remote ischaemic preconditioning and control groups.

We performed a population based study of over 100 000 women in England with early invasive breast cancer to investigate the impact of age, co-morbidity and frailty on survival outcomes after breast-conserving surgery with radiotherapy versus mastectomy (with or without radiotherapy). Our results demonstrated that the difference in standardized 5-year overall survival between the two treatments increased with age, but this was not seen for breast cancer–specific survival. These results may facilitate discussions on selection of initial breast surgery type with older women.

The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulvar and penile cancer.

The diagnostic criteria for lateral lymph node metastasis in rectal cancer have not been established. This multicentre study in Japan revealed that poorly differentiated or mucinous adenocarcinoma, extramural vascular invasion, tumour deposit and short-axis diameter of lateral lymph node ≥ 6.0 mm were independent risk factors for lateral lymph node metastasis. Machine learning models combining these multiple risk factors contribute to improving diagnostic performance of lateral lymph node metastasis.

This study examined whether two malleable psychological skills (psychological flexibility and resilience) mediated the relationship between personality traits and mental health in surgeons. Our findings suggest that it is not only a surgeon’s personality that predicts their mental health, but the extent to which a surgeon demonstrates these specific psychological skills. This has important implications for improving surgeons’ mental wellbeing, because psychological skills can be successfully targeted with interventions in a way that personality traits cannot.

In oesophageal squamous cell carcinoma, the use of robot-assisted minimally invasive oesophagectomy led to fewer cases of pneumonia and faster recovery compared with conventional minimally invasive oesophagectomy. Additionally, robot-assisted minimally invasive oesophagectomy significantly improved the feasibility and safety of performing lymph node dissection along the recurrent laryngeal nerve.

This is a retrospective multicentre study on the effect of margin clearance on survival among pancreatic ductal adenocarcinoma patients with nodal involvement. This study shows that a margin clearance greater than 1 mm does not result in a better prognosis. Oncological therapy remains an essential way to improve the prognosis among these patients.

Outcomes of extended pancreatic resections performed from 2015 to 2022 at the Tata Memorial Centre, Mumbai were compared to previously published data from an earlier time period in this retrospective analysis. An increased use of neoadjuvant therapy along with an increased complexity of surgical resection was noted. Surgical outcomes were comparable despite increased complexity. Disease-free survival of node-positive resectable pancreatic cancers was improved.

This study analysed the most recent nationwide survey (2010–2018) to assess the validity of the new Japanese criteria for living donor liver transplantation for hepatocellular carcinoma patients and identify factors associated with a poor prognosis. The 5-5-500 rule, in conjunction with the Milan criteria, constitutes the Japanese criteria for liver transplantation in patients with hepatocellular carcinoma covered by insurance. However, even within the Japanese criteria, there are specific subgroups of recurrence risks.

A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after sequential application of two preventive bundle protocols. A 50% reduction in surgical site infections was achieved in a cohort of 32 205 patients after sequential application of the bundles. The addition of four supplementary measures to create a final 10-measure protocol increased compliance, but only incisional surgical site infections benefited from the addition, while organ/space-surgical site infections did not.

Treatment appropriateness was investigated for patients undergoing surgery for resectable non-functioning pancreatic neuroendocrine tumours. Of note, potential overtreatment occurred in nearly one-third of the treated patients and tumour diameter emerged as the sole variable capable of predicting both potential overtreatment and undertreatment. Although an increase in the percentage of appropriately treated patients has been observed over the past decade, an accurate assessment of lesions with a small radiological diameter could lead to further improvements in the selection of surgical treatment.

This study aimed to analyse the prognostic value of the total mesorectal excision grade, and identify risk factors for intramesorectal and muscularis propria resection in a population-based setting. The primary outcomes were local and distant recurrence and overall and relative survival; secondary outcomes were risk factors for intramesorectal or muscularis propria resection. Muscularis propria resection increases the risk of local recurrence but does not seem to affect distant recurrence or survival.

The PROPEL-2 prospective, randomized study looking to evaluate the role of negative pressure wound therapy for laparotomy wounds.