Volume 8, Issue 5, October 2024

The risk of metachronous colorectal cancers in patients with early-onset colorectal cancer is comparable to those with advanced age, but they can occur later and be associated with family history and Lynch syndrome, advocating the need to identify the ideal follow-up pathways in this patient population.

This review highlights the lack of generalizability of trials of watchful waiting for minimally symptomatic inguinal hernia. It demonstrates considerations for future trial design.

This study aimed to assess the impact of neoadjuvant treatment compared with upfront surgery on the long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma. A systematic review and reconstructed patient-level survival data meta-analysis including five RCTs with 625 patients revealed that neoadjuvant treatment did not significantly reduce the hazard of death compared with upfront surgery in resectable pancreatic ductal adenocarcinoma patients, suggesting that neoadjuvant treatment does not provide a substantial survival advantage over upfront surgery for this patient population.

New technologies now allow for automated analysis of operative video to generate metrics reflecting operative performance. The application of such technologies in a surgical training context is yet to be explored. The aim of this scoping review was to assess the use of automated operative video analysis in surgical training.

Meta-analysis of the comparison of neoadjuvant endocrine therapy followed by surgery to upfront surgery followed by adjuvant endocrine therapy is associated with a reduction in mastectomy rate.

We first explore the effectiveness and applicability of the ‘Learn, See, Practice, Prove, Do, Maintain’ (LSPPDM) pedagogical framework in the laparoscopic training courses for surgical residents. The LSPPDM pedagogical framework is effective and applicable in laparoscopic training courses and is conducive to improving the efficiency and quality of training, guiding the trainees from ‘virtual simulation’ to ‘live animal’ and ultimately to ‘clinical practice’.

The PLaSSo Trial is a randomized, multicentre, triple-blinded, parallel-group, placebo-controlled clinical trial evaluating the effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis. The super-oxidized solution group showed a significant reduction in overall surgical-site infection by 58% and superficial surgical-site infection by 72%, with a number-needed-to-treat of four patients. Peritoneal and wound lavage with super-oxidized solution is superior to normal saline in preventing surgical-site infection after open appendicectomy for perforated appendicitis.

The aim of this study was to assess the association of CT characteristics of an appendicolith with appendicitis severity, based on a retrospective subgroup analysis of data from the prospective clinical trials APPAC II and III.

ERAS protocol implementation is associated with a prompt and durable reduction in length of stay after colorectal surgery, independent of secular trends toward decreasing length of stay over time. This association is stronger when accounting for other determinants of length of stay and in cohorts with more complex surgeries. These results are attributable to protocol implementation, rather than specific protocol elements.

In-depth histological analyses of human and murine intestinal anastomoses to investigate the role of the serosal layer of the intestinal wall during anastomotic healing were performed. The results of the study indicate that serosal scar formation is a potential mechanism during intestinal anastomotic healing. Mesothelial cells may contribute to serosal scar formation during anastomotic healing through epithelial-to-mesenchymal transition, potentially suggesting a novel therapeutic target to prevent anastomotic leakage by enhancing the physiological process of anastomotic healing.

This population study in the Netherlands explores the treatment strategies for early rectal cancer, comparing the one-stage approach of primary total mesorectal excision with the two-stage approach of local excision followed by completion total mesorectal excision. The data from 2012 to 2020 reveal an increasing trend in the use of the two-stage approach, but local excision followed by completion total mesorectal excision is associated with a higher risk of end ostomy. Clinicians and patients should be mindful of this risk during shared decision-making for colorectal cancer treatment.

The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy group when assessing differences in outcome. Long-term quality of life was significantly lower in patients who received radiotherapy compared with patients who did not.

Heart rate variability metrics may present a feasible method to assess intraoperative stress during vascular surgery. When heart rate variability metrics surpass acceptable levels, preventative strategies that reduce stress levels in surgeons may be implemented to benefit their health and patient safety.

Missed opportunities to reduce numbers of primary major lower-limb amputation and increase limb-salvage procedures when treating chronic limb-threatening ischaemia have been identified, but potential economic savings are not well documented. The current practice scenario was compared with a hypothetical scenario in which the rate of major lower-limb amputation (above the ankle joint) was reduced, and angioplasty, open bypass surgery and arterial endarterectomy adjusted to include patients who would have undergone amputation. For 16 025 index chronic limb-threatening ischaemia procedures with a total care cost of €243 924 927, the shift away from primary major lower-limb amputation towards revascularization led to a net saving to the National Health Service of €9 645 259.

The Collaborative Acute Aortic Syndrome Project is a multicentre UK service evaluation presenting a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes.

1. Arterial position changes were detected in 55% of patients and were more usual after extended and right-sided hepatectomy.

2. Postoperative morbidities and mortality occurred more frequently in patients with severe arterial changes.

3. Arterial position change was an independent risk factor for post-hepatectomy liver failure, major complications, and mortality.

The study investigates surgical outcomes in women aged 65 years and older undergoing implant-based immediate breast reconstruction. Despite a higher rate of reoperation on in this age group, age was not found to be an independent risk factor for postoperative complications. The findings suggest that implant-based immediate breast reconstruction is safe for selected women aged 65 and older.

1. Retrieving more than 11 lymph nodes can be considered sufficient for adequate lymphadenectomy.

2. Retrieving less than 11 lymph nodes may result in inaccurate nodal staging in locally advanced rectal cancer patients after total neoadjuvant therapy.

3. We proposed for the first time that adjuvant chemotherapy is not beneficial for these patients with adequate lymphadenectomy.

Females had an almost three-fold higher negative appendicectomy rate despite lower likelihood to undergo surgery compared with males. The overuse of imaging tests, which is best exemplified by the 75.2% frequency of patients undergoing computed tomography, may lead to increased costs. Overtreatment and overuse of imaging should be addressed. When it comes to selection of risk scoring systems, Raja Isteri Pengiran Anak Saleha Appendicitis and Adult Appendicitis Score appear to be superior to Alvarado and Appendicitis Inflammatory Response in our population. Also, different population subgroups may require different scales to receive the best healthcare, for instance, Adult Appendicitis Score appears to be the best tool for risk stratification in immigrants.

This study used observational data to look at the risk of rectal cancer after subtotal colectomy for IBD. The incidence of rectal cancer after subtotal colectomy for IBD is low. Asymptomatic patients should be carefully counselled on the risks of proctectomy, especially when the indication for surgery is prophylactic without evidence of rectal dysplasia.

The mean carbon emissions for NMSC range from 29.82 to 34.31 kgCO₂eq, with consumables being the most significant contributing factor. A split-thickness skin graft results in larger carbon emissions compared with direct closure and a full-thickness skin graft. By 2035, it is estimated that NMSC surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England.

In this prospective study, a 3.3% (95% c.i. 0.6% to 5.6%) increase in the rate of major adverse events was observed when a surgeon experienced a delay in operating room scheduling or waiting time between two procedures exceeding 1 h. Optimizing operating room turnover to prevent delayed operations and waiting time is critical for patient safety.

Faecal immunochemical testing has been adopted into clinical pathways as the first-line test to investigate people with symptoms suspicious of bowel cancer. Those who do not return faecal immunochemical tests are not well studied. We found younger males from lower socioeconomic areas were more likely to not return a faecal immunochemical test, and the rates of colorectal cancer and other significant bowel disease were higher in the non-returners, therefore, clinical pathways must reflect this.

Intraoperative noise is a strong surrogate for surgical complications. The association between noise and postoperative complications is confounded by the objective surgical difficulty, which was the sole independent predictor of both intraoperative noise and postoperative complications. Thus, noise serves as an indirect marker of the challenges inherent in difficult operations, indicating that more difficult operations are usually noisier.

A national guideline for managing peripheral arterial disease was released for the English National Health Service in August 2012. The impact on revascularization rates was examined, and variation in impact associated with socioeconomic deprivation was evaluated. Introduction of the national peripheral arterial disease management guideline was associated with a reduction in admission rates for revascularization, especially for moderate peripheral arterial disease, with greater reduction in rates for moderate peripheral arterial disease in more socioeconomically deprived areas.

Across 3305 prospectively collected left-sided colorectal procedures involving a circular stapled anastomosis, stapler device manufacturer was not found to be a predictor of anastomotic leak or unplanned ICU stay. There were also no differences in rates of anastomotic leak and unplanned ICU stay according to stapler head diameter, geographical region, or surgeon experience. Patient factors remain the strongest predictors of anastomotic leak. Modest modifications to stapler technology seem unlikely to generate significant patient benefit and more radical and transformational changes may need to be explored.

Sarcopenia and systemic inflammation appear to influence prognosis in a range of disease states, including cardiovascular disease. This retrospective multicentre study included 618 patients undergoing carotid endarterectomy for symptomatic lesions. Low cervical muscle density and increased magnitude of systemic inflammation were independently associated with inferior long-term survival.

The aim of this study was to evaluate the influence of postoperative pancreatic fistula on overall survival and recurrence-free survival after pancreatoduodenectomy for adenocarcinoma. This high-volume cohort showed that grade C postoperative pancreatic fistula, based on the 2016 International Study Group on Pancreatic Surgery classification system, does not impact overall or recurrence-free survival (excluding 90-day postoperative deaths).

In this study we have developed an automatic computational quantification method that accurately portrays expert interpretation of visualized parathyroid angiography fluorescence signals during thyroid and parathyroid surgery that correlates to postoperative parathyroid gland function.