Early inflammatory signal in late-diagnosed anastomotic leakage after anterior resection ➡️doi.org/10.1093/bjsopen/zrag… Anastomotic leakage after anterior resection for rectal cancer is frequently diagnosed late, and it has been suggested that such leaks may have been present but undetected earlier. This research letter reports a post hoc exploratory analysis of a retrospective multicentre cohort of 1118 patients from 11 Swedish centres, comparing maximum C-reactive protein within 14 days after surgery by timing of leakage. Median maximum values were 108.5 mg/L without leakage, 270 mg/L with early leakage, and 167.5 mg/L with late leakage. Late-diagnosed leaks were associated with an early inflammatory signal. 👏👏👏Martin Rutegård, Josefin Segelman, Peter Matthiessen, Marie-Louise Lydrup, Jennifer Parkon behalf of the RectoLeak Study Group #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer

Rationale and design of the SENTRY trial: sentinel node and organ-preserving surgery versus segmental resection in stage I colon cancer ➡️doi.org/10.1093/bjsopen/zrag… Early-stage colon cancer is increasingly managed by local resection, after which histopathological risk factors determine whether segmental resection follows, often in patients without lymph node metastases. This research letter describes the rationale and design of SENTRY, a prospective, multicentre, partially randomised patient preference trial in the Netherlands comparing sentinel node and organ-preserving surgery, using indocyanine green and colonoscopy-assisted laparoscopic wedge resection, with segmental resection in stage I colon cancer. The primary outcome is 3-year overall recurrence, with a feasibility phase of 40 patients preceding the main non-inferiority phase. 👏👏👏Bart C T van de Laar, Daan J Sikkenk, Pieter J Tanis, Paul M Verheijen, Matthijs P Schwartz, Halil Akol, René Arensman, Frank J Voskens, Leon M G Moons, Wouter H de Vos tot Nederveen Cappel, Henderik L van Westreenen, Wouter B Nagengast, Esther C J Consten #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #colorectalcancer #protocol #MinimallyInvasive

Revisiting lymphatic dissemination in gastric cancer: insights from a large Western multicentre cohort ➡️doi.org/10.1093/bjsopen/zrag… This invited commentary discusses a Western multicentre retrospective cohort study of 950 patients from five European centres that examined patterns of lymph node spread in gastric cancer. The commentary considers whether nodal dissemination in Western patients follows the Eastern pattern, in the context of growing interest in less extensive gastrectomy. Diffuse and mixed histological subtypes were associated with nearly twice the incidence of nodal metastasis of intestinal-type tumours, and microsatellite-unstable tumours showed lower nodal involvement. The authors emphasise accurate specimen dissection and suggest that fluorescence-guided surgery may improve nodal assessment. 👏👏👏Marcus Fernando Kodama Pertille Ramos, Rubén Aguilar Zapag, Carlos García Carrasco #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #UpperGISurgery #GastricCancer #GISurg #SurgicalOncology

Long-term oncological outcomes after nipple-sparing mastectomy and implant-based immediate breast reconstruction in a population-based cohort of breast cancer patients ➡️doi.org/10.1093/bjsopen/zrag… The oncological safety of nipple-sparing mastectomy (NSM) relative to skin-sparing mastectomy (SSM) remains debated. This population-based cohort study of 1537 women (1594 breasts) with breast cancer undergoing implant-based immediate reconstruction in Stockholm between 2005 and 2015 compared recurrence and survival after NSM (218 breasts) and SSM (1376 breasts). The 12-year cumulative incidence of local recurrence was 14.1% after NSM and 3.7% after SSM (adjusted HR 2.08, 95% c.i. 1.01 to 4.28), while overall survival did not differ significantly. These findings bear on patient selection for nipple preservation; the contribution of residual breast glandular tissue requires further study. 👏👏👏Helena Sackey, Ira Oikonomou, Yihang Liu, Axel Frisell, Hannah Coudé Adam, Dhirar Ansarei, Martin Halle, Anna L V Johansson, Jana de Boniface #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #BreastSurgery #BreastCancer #OncoPlastic #BreastReconstruction

Elective cholecystectomy benchmarks: nationwide registry study ➡️doi.org/10.1093/bjsopen/zrag… Standardised benchmarks for elective laparoscopic cholecystectomy remain lacking. This registry-based study applies the Achievable Benchmark of Care methodology to 48 564 patients undergoing primary elective laparoscopic cholecystectomy across 81 Swedish surgical facilities between 2015 and 2023. The benchmark for severe postoperative complications (Clavien–Dindo ≥ III) was 1.0%, compared with an observed rate of 1.7%, and the benchmark for serious intraoperative adverse events was 0.2%, compared with 0.5%. ASA class ≥ III, previous abdominal surgery, and altered gallbladder morphology were independently associated with severe complications. These benchmarks may serve as reference values for facility self-audit. 👏👏👏Ebba Kihlstedt Pasquier, Ellen Andersson, Johanna Österberg, Per Sandström, Bergthor Björnsson #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #GeneralSurgery #Laparoscopy #QualityImprovement

The iBRA-NET localization study: international IDEAL 2a/2b multicentre cohort study comparing the safety and effectiveness of wire- and radar-guided localization for impalpable breast lesions ➡️doi.org/10.1093/bjsopen/zrag… Wire-guided localization, the historical standard for impalpable breast lesions, carries logistical constraints and a risk of preoperative dislodgement. This IDEAL 2a/2b multicentre platform cohort study compares SCOUT® radar-guided localization (979 eligible patients, 27 units, 2021–2024) with a historical wire-guided cohort (1170 patients). Index lesion identification was 95.2% with radar and 99.1% with wire (P = 0.001); after excluding neoadjuvant chemotherapy, rates were 99.6% and 98.9% (P = 0.114). Positive margins were 9.0% versus 15.0% (P < 0.001), with similar re-excision rates, and operations started earlier with radar localization. The authors conclude radar localization is a safe, effective technique. 👏👏👏Rajiv V Dave, Jenna Morgan, Simon Lowes, Robert Milligan, Rachel Foster, Emma Barrett, Amtul R Carmichael, Suzanne Elgammal, Edward St. John, Chris Holcombe, Yazan Masannat, Shelley Potter, Suzanne Krizak, Vidya Raghavan, James Harvey, on behalf of the iBRA-NET Localisation Study collaborative #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #BreastSurgery #BreastCancer #OncoPlastic

Association between preoperative physical exercise and the risk of postoperative venous thromboembolism: nationwide population-based cohort study ➡️doi.org/10.1093/bjsopen/zrag… Preoperative exercise is promoted within prehabilitation programmes, yet the association between habitual exercise and postoperative venous thromboembolism (VTE) remains unclear. This nationwide population-based cohort study analyses 118 340 adults who underwent surgery and preoperative health screening in the Korean National Health Insurance Service–National Sample Cohort (2009–2016). Self-reported preoperative exercise was associated with a lower risk of postoperative VTE (adjusted odds ratio [aOR] 0.69, 95% c.i. 0.49–0.99), with the lowest risk among patients exercising three or more times per week (aOR 0.66, 95% c.i. 0.45–0.96). These findings identify exercise frequency as a modifiable factor associated with VTE risk. 👏👏👏Chan-Sik Kim, Bumwoo Park, Hyeong-Seok Yoon, Ji-Hoon Sim #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #Prehabilitation #VenousThromboembolism #PerioperativeCare #GeneralSurgery

Outpatient non-operative treatment of uncomplicated acute appendicitis: meta-analysis ➡️doi.org/10.1093/bjsopen/zrag… Antibiotic-first treatment is an accepted option for selected patients with imaging-confirmed uncomplicated acute appendicitis, yet the need for hospital admission remains uncertain. This systematic review and meta-analysis of three comparative studies (1064 patients; 502 outpatient, 562 in-hospital) found that outpatient management was associated with a lower 30-day appendicectomy rate (OR 0.52, 95% c.i. 0.36 to 0.76), with similar overall complications and unplanned healthcare use. Certainty of evidence was low to very low. Outpatient antibiotic treatment may be feasible in appropriately selected patients within structured pathways offering prompt reassessment. 👏👏👏Mauro Podda, Adolfo Pisanu, Fausto Catena, Marco Ceresoli #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #EmergencySurgery #AcuteCare #Appendicitis #SystematicReview #MetaAnalysis

Methodological challenges in surgical randomized trials: systematic review of rectal cancer studies ➡️doi.org/10.1093/bjsopen/zrag… Surgical randomized clinical trials have structural features that may complicate appraisal with standard frameworks. This methodological systematic review used rectal cancer surgery as a high-complexity exemplar: of 1529 records, 45 publications reporting on 35 trials were included and classified into five surgical trial categories. Surgically specific challenges were most frequent in RoB 2 domains D2 (deviations from intended interventions) and D4 (outcome measurement), and in GRADE indirectness. These challenges appear to reflect structural features of surgical trial design rather than obvious methodological shortcomings; contextualized appraisal may inform future trial design and evidence synthesis. 👏👏👏Daichi Kitaguchi, Mariano Giménez, Antonello Forgione, Tatsuya Oda, Jacques Marescaux #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #RectalCancer #CRCSurg #SystematicReview #EvidenceBasedSurgery

Costs and health burden of surgical site infections and anastomotic leakage in major abdominal surgery ➡️doi.org/10.1093/bjsopen/zrag… Prospective data on the societal costs of surgical site infection (SSI), including anastomotic leakage, remain limited. This secondary analysis of the multicentre EPO2CH randomized trial evaluated costs and quality of life within 90 days in 1119 patients undergoing elective abdominal surgery. SSI was associated with higher mean total costs (€53 562 versus €23 969; difference €29 592), with the greatest difference observed for anastomotic leakage (€56 401). SSI was also associated with a mean loss of 0.035 quality-adjusted life-years, corresponding to 12.78 days in perfect health. These estimates may inform resource allocation for SSI prevention. 👏👏👏Nathan Bontekoning, Hannah Groenen, Stijn W de Jonge, Markus W Hollmann, Marja A Boermeester, Marcel G W Dijkgraaf, Niels Wolfhagen, on behalf of the EPO2CH Study Group #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #SurgicalSiteInfection #AnastomoticLeak #HealthEconomics #GeneralSurgery

Role of circulating tumour DNA in predicting complete clinical response and local regrowth after total neoadjuvant therapy for rectal cancer: meta-analysis ➡️doi.org/10.1093/bjsopen/zrag… Non-operative management after total neoadjuvant therapy (TNT) for locally advanced rectal cancer depends on accurate identification of clinical complete response (cCR). This systematic review and meta-analysis of six studies (597 patients) examines post-TNT circulating tumour DNA (ctDNA) status. ctDNA negativity was associated with a higher likelihood of cCR (OR 8.01; 95% c.i. 1.43 to 44.90), whereas the association with sustained cCR was not statistically significant. Sensitivity for residual local disease and local regrowth was low. The findings support interpretation of ctDNA as a complementary tool for systemic risk stratification alongside established anatomical assessment. 👏👏👏Nikhil Lal, Siddharth Shukla, Nicola Hodges, Gina Brown, John T Jenkins #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #RectalCancer #ctDNA #MetaAnalysis #SurgicalOncology

Anterior tumour location as a risk factor for local recurrence after laparoscopic surgery for stage I ultra-low rectal cancers: exploratory analysis of the Ultimate trial ➡️doi.org/10.1093/bjsopen/zrag… Local recurrence remains a clinical concern after curative resection of early rectal cancer, and anterior tumour location is an established risk factor in advanced disease. This exploratory analysis of the prospective multicentre phase II Ultimate trial included 297 patients with cT1–2 N0 M0 ultra-low rectal cancer (≤ 5 cm from the anal verge) who underwent laparoscopic resection at 47 Japanese institutions. Three-year cumulative local recurrence was 11.9% for anterior and 3.0% for non-anterior tumours (HR 4.46), with the association most pronounced in cT2 disease. These findings indicate a need for refined treatment planning and vigilant surveillance. 👏👏👏Atsushi Kohyama, Shinobu Ohnuma, Yuichiro Tsukada, Michiaki Unno, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Tamuro Hayama, Koki Otsuka, Yusuke Inoue, Kazuki Ueda, Yuji Toiyama, Satoshi Maruyama, Shigeki Yamaguchi, Keitaro Tanaka, Motoko Suzuki, Toshihiro Misumi, Takeshi Naitoh, Masahiko Watanabe, Masaaki Ito and the Ultimate Trial Group in the Japan Society of Laparoscopic Colorectal Surgery #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #RectalCancer #Laparoscopy #SurgicalOncology