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Surgical science advances at an extraordinary pace, and all surgeons have a duty to keep up to date to offer their patients treatment based on the latest research.
Surgical science advances at an extraordinary pace, and all surgeons have a duty to keep up to date to offer their patients treatment based on the latest research.
The following tweets were posted between April 1st and April 29th, 2023. They contain useful information and insights about various topics related to surgery. You can browse through them and find the ones that are most relevant to your interests and needs.
Coping with anastomotic leaks, harder when older? Tweeted by @BJSurgery on April 1st:
Lies, damn lies, and statistics. On April 3rd @BJSurgery shared a paper on probability, P values, and statistical significance: instructions for use by surgeons:
It may not sound sophisticated, but it is extremely important. On April 10th, @BJSurgery shared the NINJA multicentre randomized clinical trial investigating the effectiveness of nail bed repair in children with or without replacing the fingernail:
@BJSOpen ran a Twitter poll on the use of ursodeoxycholic acid to treat gallstone disease on April 16th. Of the 269 participants, 52.8% voted that they do not use it:
On the same day, @BJSurgery tweeted an open access paper on double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer:
An interesting #systematicreview and meta-analysis of machine learning models in kidney TPL found they could improve prediction of graft survival. An overall model including 29 models showed sens & spec of 0.81 and AUC of 0.82. It was tweeted by @BJSOpen:
On April 25th, @BJSAcademy tweeted the first of a series on AI: “Basic Introduction to Artificial Intelligence” The aim is to describe how it works and its importance to healthcare:
🆕"Basic Introduction to Artificial Intelligence" by @tejedorpat is now available!
This is the first of a series on AI, aiming to describe how it works and its importance to healthcare.
@BJSAcademy tweeted #BJSBookshelf: Top Knife: The Art and Craft of Trauma Surgery, on April 28th. We recommend you read the review by Teresa Perra & Alberto Porcu:
🔥#BJSBookshelf: Top Knife: The Art and Craft of Trauma Surgery🔥
⭐️Not specifically aimed at Trauma Surgeons.
⭐️Read in a day but keep close at hand to refer to whenever you need to.
On April 29th, @BJSOpen tweeted a #systematicreview of training surgeons to optimize communication and symptom management in patients with life-limiting conditions:
Schmidt TSB, Li SS, Maistrenko OM, et al. Drivers and determinants of strain dynamics following fecal microbiota transplantation. Nature Medicine (2022). 28(9), 1902-1912
Faecal microbiota transplantation (FMT) is currently recommended in the UK by the National Institute for Health and Care Excellence (NICE) for the treatment of recurrent Clostridioidesdifficile infection (rCDI)1. Additionally, FMT is being extensively investigated for its potential application in surgical diseases, like the prevention of anastomotic leak2, as well as in ulcerative colitis (UC) and its related surgical complications, such as pouchitis3. Modulation of the faecal microbiome has significant implications for surgeons, as emerging evidence suggests pre-operative optimisation of the gut microbiota enhances patient outcomes and reduces surgical risks, such as surgical site infection, postoperative ileus and anastomotic leak4, 5, 6.
However, the mechanisms underlying how FMT has therapeutic benefits remain largely unclear, and accurate outcome predictions are elusive. This remains a fundamental barrier to the wider adoption of this therapy in clinical practice. The recent analysis by Schmidt et al. is therefore of significant importance, as it provides highly novel insights into how FMT works. They conducted a comprehensive meta-analysis investigating the determinants of FMT response in ten different diseases, focusing on strain dynamics and the ecological response, and specifically on donor-recipient microbiota interactions. The researchers assessed strain-level colonisation patterns, resilience, coexistence, and turnover of recipient strains after FMT, developing cross-validated models to predict FMT outcomes by linking significant clinical variables to ecological processes. Their study found that factors of the recipient’s microbiome and donor-recipient microbiome complementarity were primary drivers of both strain dynamics and FMT efficacy.
To investigate the strain dynamics of the donor and recipient microbiome, the authors conducted a meta-analysis on 1,492 faecal metagenomes obtained from 316 FMTs, pre- and post-FMT, used for ten different diseases, including rCDI and UC. They discovered a change in the recipient’s microbiota towards new strains or strains which were at undetectable levels pre-FMT, rather than full rejection or conversion to donor microbiota. This change to new strains was attributed by the authors to the FMT-induced disturbance of the recipient microbiota, rather than the FMT’s content. Donor strain takeover and recipient strain persistence were observed, but only in species that were exclusively present in either the donor’s or recipient’s pre-FMT microbiota. When species were detected in both donor and recipient pre-FMT, coexistence of strains was most common. While donor and new strain takeover were characteristic in certain diseases (mostly UC and rCDI), interestingly, clinical outcomes did not correlate with strain-level changes in any disease. This lack of correlation extended to the metabolome, where increased levels of short-chain-fatty-acid (SCFA) producing bacteria post-FMT also didn’t correlate with clinical outcomes.
To identify factors associated with colonisation outcomes, the authors trained predictive machine learning models using cross-validated Lasso-regularised linear regression. Moderate accuracy was achieved for predicting post-FMT coexistence and recipient strain persistence (LASSO R2=0.58 and 0.49, respectively), while donor colonisation (R2=0.34) and pre-FMT recipient strain resilience (R2=0.35) showed lower variation. Recipient factors or donor-recipient microbiome complementarity were more predictive than donor factors. Recipient species richness and abundance of selected species pre-FMT were important predictors of strain-level outcomes. Interestingly, no individual species’ abundance post-FMT was strongly associated with colonisation outcomes. Successful colonisation of specific species in the recipient, such as B. uniformis, B. vulgatus, and several Oscillospiraceae and Lachnospiraceae species, was highly predictive of donor strain colonisation, suggesting these species may serve as indicators of successful engraftment.
The authors then investigated strain dynamics within each species post-FMT by focusing on 307 species detected in over 50 allogenic FMTs. They observed no consistent patterns of colonisation or persistence and instead found a strong propensity toward donor-recipient strain coexistence, independent of initial strain abundances. Strain-level FMT outcomes varied within each major taxonomic group. Facultatively aerobic species colonised less successfully, while strains with specific metabolic pathways showed higher colonisation success. The authors furthermore found moderate accuracy in predicting resilience of the recipient’s microbiome, donor colonisation, and takeover of donor microbiome. However, high accuracy was observed in predicting recipient strain turnover across almost all species, suggesting that recipient strain displacement may generally be a more deterministic process.
They further demonstrated that species-specific strain dynamics were primarily driven by the recipient microbiome, observing exclusion and facilitation effects. The majority of interactions were inhibitive, with an abundance of specific species in the recipient correlating negatively with the engraftment of colonisation of donor bacteria. Exclusion effects were furthermore stronger for the recipient’s resident community than the donor’s. Colonisation inhibition by the recipient’s microbiome was phylogenetically concentrated, being more common between related species. Bacteroidales species in the recipient microbiota, particularly B. uniformis, B. vulgatus, Alistipes shahii, and Parabacteroides distasonis, were among the strongest colonisation inhibitors and classified by the authors as possible ‘gatekeeper species’.
In contrast, Lactococcus lactis, Streptococcus salivarius, and Dialister invisus in the recipient were the primary colonisation facilitators, typically affecting phylogenetically distant species. Only a few notable predictive species were observed in the donor microbiota, such as B. vulgatus and Evtepia gabavorous. Facilitation and inhibition effects of donor species were generally limited and less predictive of colonisation success, indicating that the donor microbiota has a minimal impact on colonisation outcomes.
However, these species-specific patterns of turnover were superseded by microbiome-level features. Two critical microbiome-level elements accurately predicted strain turnover: pre-FMT species richness in the recipient and donor-recipient dissimilarity. The latter emerged as the most potent FMT outcome predictor, driven by the recipient’s microbiome. A complementary donor microbiome facilitated donor colonisation, but a diverse recipient microbiome remained resilient to colonisation even with high complementarity. Successful colonisation primarily involved donor species occupying an empty niche in the recipient microbiome. Overall, donor microbiome composition exerted a minimal impact on species-specific strain dynamics. These dynamics are especially interesting, as the dissimilarity between diseased and healthy control microbiota has been recognised as a hallmark for numerous FMT indications.
The authors concluded by emphasising that the recipient’s microbiota primarily drives FMT outcome, while the donor microbiota’s role remains ambiguous, see figure 1 for a summary of the recipient’s microbiome in driving donor strain takeover. They further conclude that rCDI and UC were the most responsive conditions to FMT, as treatment led to increased donor bacteria colonisation and clinical response rates, however, as both diseases are often preceded by antibiotic treatment, this should be considered with care. The authors additionally found no evidence supporting that any species is intrinsically more invasive or resilient. Rather, structured species interactions determine outcomes and can be predicted to some extent, with recipient strain turnover being well-predicted, but donor strain takeover not.
This meta-analysis is limited, however, by its focus on the bacterial microbiome and underrepresentation of certain conditions in their dataset. The authors furthermore acknowledge that colonisation may be influenced by variables not examined in this study, notably viral, eukaryotic microbiota, or recipient immunological factors, as well as medication or viability of donor anaerobes following FMT. Finally, the authors propose that future FMT candidates should be stratified based on microbiome richness and ‘gatekeeper’ species, while donor selection should only be taken into consideration for its complementarity with the recipient’s microbiome.
Baseline recipient microbiome diversity and donor-recipient complementarity have been previously theorised to affect FMT outcome, although much of the literature focuses on immunological compatibility7. This meta-analysis offers insight into the role of the microbiota itself on donor-recipient compatibility. Schmidt et al. ecological approach to FMT builds on the work of Gibbons et al. (2020)8, who hypothesized that the evolution of the gut microbiota might be modelled after that of natural ecosystems. The indicator species identified by Schmidt et al. parallel the pioneer species necessary for other species to thrive in larger-scale ecosystems.
However, the lack of relationship between strain dynamics and clinical outcome in all diseases examined in this meta-analysis, including rCDI and UC, suggests the mechanism behind successful treatment with FMT remains obscure. Nevertheless, the importance of the recipient microbiome repeatedly demonstrated in this article builds a strong foundation for the adoption of a more recipient-centred approach over a donor-centred one. Moving away from a search for ‘super-donors’ with an ideal microbiome signature in favour of donors with high donor-recipient complementarity could achieve higher FMT response rates. This means that clinical studies of FMT must move towards detailed phenotyping of the recipient microbiome before any surgical intervention. This is likely to become increasingly important as trials of FMT in surgical diseases become more prevalent.
This study included 84 patients. The healing rate after six moths was better with the tract ligation method: 76.2 versus 54.7 per cent, P=0.039. All patients were continent at two years.
Ghaneh P, Palmer D, Cicconi S, Jackson R, Halloran CM, Rawcliffe C et al, for the European Study Group for Pancreatic Cancer.
Lancet Gastro Hepatol 2023; 8: 157-168.
This study included 83 evaluable patients from 478 screened. Neoadjuvant treatment did not reduce the resection rate. Neoadjuvant treatment improved 1-year disease-free survival in both groups combined: 59 versus 39% for immediate surgery (hazard ratio 0.53, 95 per cent confidence interval 0.28 to 0.98, P=0.016.
Comment: The evidence for neoadjuvant chemotherapy is accumulating, but the number of suitable patients may be small.
Patel SP, Othus M, Chen Y, Wright GP, Yost KJ, Hyngstrom JR et al.
N Engl J Med 2023; 388: 813-823.
Some 313 patients with advanced melanoma undergoing surgical resection followed by one year of adjuvant Pembrolizumab, were randomly allocated three additional doses of Pembrolizumab preoperatively. After two years, event-free survival was significantly better with the neoadjuvant treatment: 72 versus 49 per cent, P=0.004.
Comment: This is important evidence for the benefit of neoadjuvant treatment for melanoma.
van der Veen A, van der Meulen MP, Seesing MFJ, Brenkman HJF, Haverkamp L, Luyer MDP et al. for the Laparoscopic vs Open Gastrectomy for Gastric Cancer (LOGICA) study group.
JAMA Surg 2023; 158:120-128.
A total of 227 procedures were included. Costs of initial surgery were higher for laparoscopic compared with open procedures, but by one year there was only a 3 per cent cost difference between the interventions.
Comment: Surprisingly little difference. Justifies either approach.
Kimball AB, Jemec GBE, Alavi A, Reguiai Z, Gottlieb AB, Bechara FG et al.
Lancet 2023; 401: 747-761.
This analysis of two identical trials included over one thousand patients. Secukinumab given fortnightly was more effective in both trials at reducing the signs of symptoms of hidradenitis than placebo (or Secukinumab every four weeks).
The study included 176 patients awaiting colon cancer surgery. Preoperative immunonutrition did not reduce the risk of infectious complications (17.7 versus 15.9 per cent in controls) or overall complications (31.6 versus 29.3 per cent).
Over 5000 patients were included in this multicentre trial. Thirty-day mortality was 0.56 per cent (n = 14) in the control and 0.44 per cent (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34–1.62).
Comment: Would results have been different if the focus had been on high risk patients only?
Jain A, Greig AVH, Jones A, Cooper C, Davies L, Greshon A for the NINJA Collaborative.
Br J Surg 2023, 110: 432-438.
In this study that included 451 children, discarding the nail after repair was not associated with an inferior outcome (infection/cosmesis), but reduced overall costs by a mean of 84 euros.
Almeida I, Gonqalves AC, Corrêa FB, Castro J, Guirro E, Farina JA et al.
Ann Surg 2023; 277: 198-205.
Patients with burn contractures at least one year old were randomized to split skin grafting alone, or with the addition of one of three dermal matrix preparations. Detailed scar assessment showed no improvement over skin grafting alone with any of the dermal matrices.
Comment: Disappointing outcome for the dermal matrices.
On March 1st, the second @BJSAcademy essay writing competition was launched. All medical students and young trainees are invited to send their essays on “Something interesting I learnt in the operating room”:
📢Medical Students and Young Trainees!
🔥Launch of the second essay writing competition: Something interesting I learnt in the operating room…
Submissions to ➡️carol@bjsacademy.com
NOTE: the winners of the first essay writing competition will be announced end of March pic.twitter.com/F1ti3S9I6K
On the 3rd of March, comments related to the variation in limb amputation rates in Denmark and it’s becoming a national scandal were discussed. In the age of tweets and fast responses, it is sometimes necessary to take a moment to carefully analyse results that can become great reasons for debate:
Gender stereotypes and bias continue to prevail in our culture, and Medicine and Surgery are no exception. On the 5th of March, ‘Gender divergence: scoping the surgical gap’ was published on @BJSurgery:
March is the #ColorectalCancerAwarenessMonth, and several publications have appeared on @BJSurgery and @BJSOpen to highlight relevant research regarding this prevalent disease:
Early-onset colorectal cancer (#EOCRC, <50y) is increasing worldwide with many underlying reasons not yet elucidated. A thread of @OUPMedicine covering @BJS articles which shed light on this important issue has been published during #ECCAM2023:
Again, studies regarding outcomes based on surgical volume are a matter of debate. In this case, bariatric surgery is s in the spotlight. You can see more on @BJSurgery, and it was tweeted on March 22nd:
On March 30th, @BJSAcademy tweeted the last call for applications for a BJS Society Social Media Lead who will coordinate activity across @BJSurgery @BjsOpen and @BJSAcademy:
Last call for applications – deadline tomorrow!
BJS Society are looking to appoint a Social Media Lead to coordinate activity across @BJSurgery@BjsOpen and @BJSAcademy
De Wijkerslooth EML, Boerma E-JG, van Rossem CC, van Rosmalen J, Baeten CIM, Beverdam FH et al, for the APPIC Study Group.
Lancet 2023; 401: 366-376.
Some 1066 patients were included; 95% had a laparoscopic appendicectomy. The rate of postoperative infection or death within 90 days was similar after two (10 per cent) and five days of antibiotics (8 per cent; risk difference 2 per cent, 95 per cent confidence interval-1.6 to 5.6 per cent). Readmission to hospital was more common after the two day course: 12 versus 6 per cent).
Comment: Very useful pragmatic trial that will assist decisions made in all acute hospitals, and significantly reduce antibiotic use.
Ringblom C, Odensten C, Strigård K, Gunnarsson U, Näsvall P.
Ann Surg 2023; 277: 38-42.
Some 154 patients were evaluable after three years. There was no significant difference in clinical or radiological rates of stoma hernia, or reintervention.
Comment: One of a number of similar trials, with varying results. Clearly not as definitive as for abdominal wounds.
Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM.
N Engl J Med 2023; 388: 585-594.
The study included 1326 women aged 65 or over with ER+ve breast cancer completely excised. After a median follow-up of 9.1 years, the addition of whole breast radiotherapy reduced the risk of local recurrence (0.9 versus 9.5 per cent, P<0.0001), but did not affect overall survival: 80.7 versus 80.8 per cent, respectively.
Comment: Very helpful study that enables women to make a choice.
Wei Y, Wu J, Yuxin C, Fan K, Yu X, Li X et al, on behalf of the PL-5 Investigators.
Ann Surg 2023; 277: 43-49.
This study examined the use of a new antimicrobial spray compared to silver sulphadiazine in 220 patients with a skin wound infection. Use of the spray at four varying doses all improved healing rates significantly (P<0.05).
Comment: This seems to be working more like an antiseptic.
Some 1349 kidneys were transplanted from 725 deceased donors. Hypothermia was inferior to machine perfusion (or both) in terms of delayed graft function (30 versus 19 per cent), but after one year, graft survival rates were similar.
Comment: So the question is whether reduced delayed graft function is sufficient justification for machine perfusion.
Wan J, Wang S, Yan B, Tang Y, Zheng J, Ji H et al.
BJS Open 2022; 6: zrac151.
In this study that included 66 procedures, use of indocyanine green detected a median of two more nodes during dissection. The median number of positive nodes was similar in the two groups.
Comment: Elegant, but may not affect clinical outcomes.
Pieniowski EHA, Bergström CM, Nordenvall CAM, Westberg KS, Johar AM, Tumlin E et al.
Ann Surg 2023; 277: 30-37.
Forty-five patients were included in this study. Irrigation reduced symptom scores after 12 months (22.9 versus 32.4, P=0.002), and improved quality of life.
Comment: Daily irrigation of the rectum to keep it empty certainly helps some patients with this distressing symptom.
Scheerders ERY, van der Velden SK, Goossens LMA, Hamann SAS, de Maeseneer MGR, Malskat WSJ et al, for the members of the SAPTAP group.
Br J Surg 2023: 110: 333–342.
Some 464 patients had ambulatory phlebectomies first; 227 were randomized to subsequent saphenous trunk ablation. Only 57 (25 per cent) of patients who had phlebectomies alone required later truncal ablation on symptomatic grounds. Overall disease-specific quality of life was similar in both groups at one year.
Comment: This revolutionary study reverses the standard treatment of truncal ablation first. Longer term outcomes are needed to test the hypothesis fully.
Caffeine and postop ileus after lap colorectal surgery: yes or no? Marcel André Schneider @MA_Schneider shared a @BJSurgery article reporting the results of a RCT:
On February 11th, Prof. Jose Balibrea @BalibreaJose tweeted a comment in Spanish about a @BJSOpen #researchletter on gastroparesis and bezoar formation in patients with GLP-1 antagonists and the potential implications of MBS patients:
How to manage general surgical emergencies in pregnant and breastfeeding woman? @BJSurgery recently published the international guidelines and they were shared by @drnaumanAhmed on Twitter on February 13th:
@BJSOpen tweeted the results of a poll for endocrine surgeons with the following question “What is the most important consideration when choosing your skin closure after thyroid/parathyroid surgery?” on February 26th:
On February 27th, Prof. Russell Petty @RussellPetty19 tweeted a summary of a @BJSurgery paper on the impact of Covid19 on gastroesophageal cancer patients:
Serra-Aracil X, Zarate A, Bargallo J, Gonzalez A, Serracant A, Roura J et al for the Ta-LaTME study Group.
Br J Surg 2023; 110: 150–158.
This study included 105 evaluable patients. Conversion to open surgery was needed after 20 per cent of transanal, versus 2 per cent of laparoscopic procedures, P=0.003. Morbidity rates, and postoperative recovery were similar. After a median of 39 months recurrence rates were similar: 6.1 percent laparoscopic, and 1.8 per cent transanal surgery.
Comment: This is a brave study, but really too small to answer many of the questions that remain about TaTME. Longer term follow-up will be important.
Wang N, Yang J-W, Yan S-Y, Lu Y, Han J-G, Pei W et al.
JAMA Surg 2023; 158: 20-27.
This intervention was used as part of an ERAS protocol in 248 patients having laparoscopic colorectal resection. Electroacupuncture reduced the median time to first defaecation (76.4h vs. 90h in controls, P=0.003), and reduced the rate of prolonged ileus (10 vs. 20 per cent, P=0.03), with no severe adverse events.
Comment: Possibly worth trying, if these results are corroborated, and particularly if it reduces duration of hospital stay.
Kurokawa Y, Doki Y, Mizusawa J, Yoshikawa T, Yamada T, Kimura Y et al.
Br J Surg 2023; 110: 50–56.
This study that was terminated early after interim analysis, included 1204 procedures. The addition of total resection of the bursa omentalis did not improve overall 5-year survival compared to omentectomy alone: 74.9 versus 76.5 per cent respectively, P=0.59.
Lin J-X, Lin J-P, Wang Z_K, Li P, Xie J-W, Wang J-B et al.
JAMA Surg 2023; 158: 10-18.
In this study that included 526 patients with proximal gastric cancer that had not invaded the greater curvature, the studied procedure did not improve 3-year disease-free survival compared to standard gastrectomy: 70.3 vs. 64.3 per cent, respectively, P=0.11).
Comment: Subgroup analysis suggested that patients with advanced posterior gastric cancer may benefit from this procedure.
In this study that included 440 procedures, after a median of 45.4 months, adjuvant S-1 therapy given for four cycles improved overall survival from 67.6 to 77.1 per cent, P=0.008.
Comment: A benchmark study for this rare condition, that provides a real hope of improved survival.
Ishii K, Yokoyama Y, Yonekawa Y, Hayashi D, Kinoshita F, Kuwatsuka Y et al.
Br J Surg 2023;110: 159–165.
This trial that included 218 procedures did not show any difference in intra-operative blood loss with (mean 695ml), or without tranexamic acid (667 ml). Other secondary outcomes were also similar.
Comment: Surprising, since tranexamic acid does seem to be beneficial in most operations with significant blood loss.
For the first time since 1913, @BJSurgery was not printed in January 2023. Now, it will only be published online. The two journals, BJS and BJS Open, together with the BJS Academy, are leading the digital transformation of surgical research dissemination. Many changes will be announced soon, but in the meantime, let’s focus on the excellent articles shared on social media.
The first tweet of the year from @BJSurgery was on pancreatic cancer!
#BariatricSurgery is still a matter of debate. Long-term effects of BS are discussed in this new paper @BJSurgery. The tweet was published on January 6th:
A highly engaging tweet by @BJSurgery shared the “Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies” on January 20th.
On January 29th, @BJSAcademy shared Professor Derek Alderson’s post “Life in Surgery”. Prof. Alderson is Vice Chair of the BJS Society Executive Committee:
Did you read this interview with Professor Derek Alderson's "Life in Surgery", BJSS Executive Vice Chair?
A surgeon's path: training, struggling, achieving, teaching, reflecting..beyond surgery
On January 30th, @BJSOpen tweeted: “How does #digital #consent impact informed consent?” A #systematicreview of 40 papers found a generally positive effect on early and delayed comprehension. Few studies cover all aspects of informed consent:
Eight RCTs including 3203 participants were analyzed. Early optimism about the benefits of antibiotic therapy were tempered in this analysis by reduced treatment efficacy compared with appendicectomy, higher readmission rate, and no advantage in duration of stay at index admission.
Comment: Antibiotic treatment for appendicitis has a place, but not as standard therapy.
Sali L, Ventura L, Mascalchi M, Falchini M, Mallardi M, Carozzi F et al.
Lancet Gastro Hepatol 2022; 7: 1016-1023.
Some 15,000 people were randomized and invited. Attendance was lower for CT colonography (26.7 per cent versus 33.4 per cent who participated in all three faecal testing rounds). Although the detection rate was higher with CT colonography (5.2 versus 3.1 per cent, P=0.0002). Overall detection (referral to work-up) was higher after three rounds of faecal testing (7.5 versus 2.7 per cent, P<0.0001).
Comment. Interesting that compliance with screening may be more important than the accuracy of the test.
Zhang L, Cheng M, Lin Y, Zhang J, Shen B, Chen Y et al.
Br J Surg 2022; 109: 1232–1238.
In this study that included 330 women, the sentinel node identification rate was similar: 94.5 per cent with ultrasound assistance versus 95.8 per cent with dual tracer. Number of sentinel nodes, number of metastatic nodes and duration of surgery were similar between the groups.
Comment: Ultrasound-assisted carbon nanoparticle mapping was non inferior.
Feng Q, Yuan W, Li PT, Tang B, Jia B, Zhou Y et al, for the REAL Study Group.
Some 1240 patients were included in the study, and 1171 included in the analysis. Rates of positive resection margin were: robotic 4 per cent, laparoscopic 7.2 per cent, P=0.023. Complete resection rates were similarly improved: 95.4 versus 91.8 per cent, respectively. Relative postoperative complication rates were 16.2 and 23.1 per cent, P=0.003. Hospital stay was also shorter: 7 versus 8 days, P=0.0001.
Comment: The first real evidence that the robot beats the laparoscope. But what are the long term results, and are the benefits worth the increased costs?
Albers KI, Polat F, Helder L, Panhuizen IF, Snoeck MMJ, Polle S et al, for the RECOVER Study Collaborators.
Ann Surg 2022; 276: e664-e673.
A total of 178 patients were randomized to high or low pressure pneumoperitoneum. Quality of recovery score was significantly improved on day one after low pressure pneumoperitoneum (167 versus 159, P=0.005). Inflammatory markers were also reduced. Pain scores were lower and there were fewer infectious complications.
Abbassi F, Muller SA, Steffen T, Schmied BM, Warschkow R, Beutner U et al.
Br J Surg 2022; 109: 1216–1223.
Sixty patients were randomized to one of two caffeine doses given three times a day, or a control group. There was no measurable effect from caffeine; time to first bowel movement was not improved: 68.2 h after caffeine versus 67.3 h in controls (P=0.887).
Comment; Well there goes the excuse to ask for a coffee after your operation.
Kang B, Ibrahim S, Weil A, Reynolds K, Johnson T, Wilson S et al.
Ann Surg 2022; 276: 975-980.
Patients who had skin surgery with primary wound closure were randomly allocated to one of two different laser therapies for eight weeks or a control group. Fifty-two patients were eligible for analysis. Laser treatment improved wound score after 36 weeks, particularly with regards to scar thickness, stiffness and erythema.
Comment: Whether laser treatment improves wound healing still remains unproven.
As a registered charity, BJS Society’s mission to improve surgical education is underpinned by its strategic partnerships and its leading surgical journals.
Since its inception in 1913, the readership of BJS has continued to grow across the globe, paving the way for complementary open access journal, BJS Open, in 2017.
