Cutting edge blog


This section is designed to add value to the articles published in BJS and BJS Open.

If you wish to send a written (or even recorded) comment on one of the published articles, please send it to katie@bjsacademy.com.

If you wish to respond more immediately, please use social media directly by tagging @BJSurgery, @BjsOpen or @BJSAcademy


Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Ranjith Kumaran Ramu, Aryan Dwivedi, Faraz Ahmad, Kushagra Gaurav Bhatnagar, Akshay Anand, Nizamuddin Ansari, Abhinav Arun Sonkar

Correspondence to: Ranjith Kumaran Ramu (e-mail: ranjithkumaran2009@gmail.com)
Senior Resident
Department of General Surgery

14 May 2025
Author response: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Author response: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Simon Lundström, Erik Agger, Marie-Louise Lydrup, Fredrik Jörgren, Pamela Buchwald

Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)
Department of Surgery
Skåne University Hospital

14 May 2025
Comment on: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

Comment on: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

Anyin Wang, Tingting Fu, Xigui Tian

Correspondence to: Anyin Wang (email: Hospitalpwkedu@163.com)
Department of Gastrointestinal/Hernia Surgery
The People's Hospital of Liangping District

13 May 2025
Author response: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

Author response: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study

Sander J. M. van Hootegem, Bas P. L. Wijnhoven

Correspondence to: Sander J. M. van Hootegem (e-mail: s.vanhootegem@erasmusmc.nl)
Department of Surgery
Erasmus Medical Centre

13 May 2025
Non-technical error leading to patient mortality in the Australian surgical population

Non-technical error leading to patient mortality in the Australian surgical population

Jesse D Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha B Herath, John B North, Ellie C Treloar, Martin H Bruening, Adam J Wells, Guy J Maddern

Despite an increasing emphasis on patient safety, modern surgical practice is still plagued by the occurrence of serious Adverse Events (AEs). A large proportion of these AEs are caused not by technical errors, but short comings in non-technical skills (NTS) or non-technical errors.1 NTS are the cognitive and interpersonal components of surgical professionalism including communication, decision-making, situational awareness and leadership.2 Few studies have attempted to quantify the significance of non-technical errors leading to patient harm. Those that have, only include small, non-representative cohorts, or have assessed for NTS shortcomings using heterogeneous, non-standardised, and non-comprehensive assessment methods.3-6 As a result, the true impact of non-technical errors, and information about how, when, and why these errors occur are poorly understood. Evidence to guide NTS improvement is lacking.
This study7 aimed to investigate the incidence of non-technical errors linked to patient death in a large representative Australian cohort, investigate factors associated with fatal non-technical errors, and whether the incidence of non-technical errors had changed over time. To achieve this, an 8-year retrospective audit using surgical mortality cases was conducted. Data were derived from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) a mandatory, national surgical mortality audit overseen by the Royal Australasian College of Surgeons. In Australia, every surgical death is reported to ANZASM for external peer review for the purpose of identifying clinical management issues (CMI’s) that could be improved in future. CMI’s are rated on a three-tiered system with ‘area of concern’ or ‘Adverse Event’ representing the two most serious. All surgical deaths between 2012-2019 (excluding New South Wales), flagged with an area of concern or AE were included with no further exclusions. Each case was assessed using the System for Identification and Categorization of Non-technical Errors in Surgical Settings (SICNESS), a validated tool, developed by the study authors.8 The SICNESS enabled assessors to identify if a non-technical error linked to patient death had occurred, and if so, to which NTS domain it belonged.
There were 30,971 surgical deaths reported to ANZASM during the study. Of these, 3829 were flagged with an AE or Area of concern. Some 134 had insufficient information for assessment, leaving 3695 cases for review. A non-technical error linked to patient death was identified in 2354 cases (63.7%). Of the cases with non-technical errors, 1375 (58.4%) had decision making errors, 1328 (56.4%) had situational awareness errors, 357 (15.2%) had communication/teamwork errors, and 128 (5.44%) had leadership errors.

13 May 2025
Aortic aneurysm screening: a personal history

Aortic aneurysm screening: a personal history

Jonothan Earnshaw

____________
My first significant contact with abdominal aortic aneurysm (AAA) screening was when I was appointed as a consultant surgeon in Gloucestershire in 1991. My consultant colleague, Brian Heather, had already started an AAA screening programme for 65-year-old men in Gloucestershire. The burden of managing vascular disease single-handed for a population of 350,000 was significant for him; in addition, patients with ruptured AAA were major consumers of critical care services in Gloucestershire at the time. Brian contacted all the GP surgeries in Gloucestershire asking whether (i) they were prepared to identify the 65-year-old men in their practice each year, and then (ii) to receive a visit once a year for them to be scanned. He secured the services of a research nurse, Elaine Shaw, who took a portable ultrasound scanner to the GP surgeries to do the scans. The screening programme in Gloucestershire was born in 1988 and has run ever since1.

12 May 2025
Volatile <italic>versus</italic> intravenous anaesthesia for oesophagectomy: addressing confounding factors and temporal trends in clinical practice

Volatile versus intravenous anaesthesia for oesophagectomy: addressing confounding factors and temporal trends in clinical practice

Shuting Yin

Correspondence to: Shuting Yin (e-mail: yin13938214200@163.com)
Department of Education and Sports
Zhengdong New District

1 May 2025
Comment on: Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study

Comment on: Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study

Rajni K Sah, Sabaretnam Mayilvaganan

Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)
Additional Professor
Department of Endocrine Surgery

29 April 2025
Author response: Endoscopic appendix opening sphincter incision to remove faecolith

Author response: Endoscopic appendix opening sphincter incision to remove faecolith

Gang Bian

Correspondence to: Gang Bian (e-mail: bianganglingling@163.com)
Department of Gastroenterology
Qingdao Third People's Hospital Affiliated to Qingdao University

11 April 2025
Comment on: Endoscopic appendix opening sphincter incision to remove faecolith

Comment on: Endoscopic appendix opening sphincter incision to remove faecolith

Chahrazed Dous

Correspondence to: Chahrazed Dous
Tazoult City

11 April 2025
Introducing ‘Surgeons unscrubbed’

Introducing ‘Surgeons unscrubbed’

Dominic Slade and Prita Daliya bring you the opening teaser for their upcoming podcast: Surgeons unscrubbed! A collaboration between the British Hernia Society (BHS) and BJS Academy.
In this series, Dominic and Prita will be interviewing prominent surgeons around the world and asking them questions submitted by you!

10 April 2025
Author response: Enhancing methodological rigour in prepectoral breast reconstruction studies

Author response: Enhancing methodological rigour in prepectoral breast reconstruction studies

Shelley Potter, Kate L Harvey, Paul White

Correspondence to: Shelley Potter (email: Shelley.potter@bristol.ac.uk)
Translational Health Sciences
Bristol Medical School

25 March 2025
Enhancing methodological rigor in prepectoral breast reconstruction studies

Enhancing methodological rigor in prepectoral breast reconstruction studies

Janhavi Venkataraman, Kefah Mokbel

Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkakataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)
The London Breast Institute
Princess Grace Hospital

25 March 2025
Colorectal Cancer Awareness Month 2025

Colorectal Cancer Awareness Month 2025

In recognition, we present seven of the most important colorectal cancer studies published in BJS and BJS Open over the past year. These articles highlight significant advancements in the understanding and management of colorectal cancer, covering topics such as surgical innovations, oncological outcomes, and prognostic markers. This collection showcases the latest research aimed at improving patient care and survival.
Explore these key contributions to the field and join us in raising awareness of colorectal cancer this March.
______

24 March 2025
Comment on: Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial

Comment on: Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial

Saburi Oyewale

Correspondence to: Dr Saburi Oyewale (email: saburioyewale@yahoo.com)
Division of General Surgery
Department of Surgery

18 March 2025
Re-evaluating enoxaparin for thromboprophylaxis in liver transplantation: a closer look

Re-evaluating enoxaparin for thromboprophylaxis in liver transplantation: a closer look

Dipesh Kumar Yadav, MD, PhD, Yiren Hu, MD, PhD

*Corresponding author: Yiren Hu (email: yirenhu@hotmail.com)
Department of General Surgery
The Third Clinical Institute Affiliated to Wenzhou Medical University

13 March 2025
Author response: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Author response: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Simon Lundström, Erik Agger, Marie-Louise Lydrup, Fredrik Jörgren, Pamela Buchwald

Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)
Department of Surgery
Skåne University Hospital

11 March 2025
Insights into tumour deposit pathology

Insights into tumour deposit pathology

Antonio Manenti, Stefania Carmaschi, Luca Reggiani Bonetti, Gianrocco Manco

Correspondence to: Antonio Manenti (e-mail: antonio.manenti_2024@libero.it)
Department of Surgery
Polyclynic Hospital

11 March 2025
Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study

Feng Chen, Min Ni

Correspondence to: Min Ni (email: 15278054120@163.com)
Department of Gastrointestinal Surgery
The Second Nanning People’s Hospital

11 March 2025
On the importance of idle curiosity in research

On the importance of idle curiosity in research

John C Alverdy MD FACS FSIS

In the book “The Idea Factory,” the CEO of the then monopolized telephone services American Telephone and Telegraph Company (AT&T)) in the US (circa 1880-1930) decided that although the business was highly profitable as a result of the massive laying down of cable across the world, hiring someone who could advance an understanding of how the telephone actually worked was needed. He decided that a more fundamental understanding of electricity and sound would improve the business model and overall telephone services. He hired a physicist from the University of Chicago who was offered a salary of $25,000/year to head up the project. This person was thrilled to just be able to obtain employment, given that a PhD in those days was no guarantee of employment, even when graduating from an elite university.
When the newly appointed physicist asked the CEO “what is my job?” he responded — you are to spend your time in “idle curiosity” so you can think and perform experiments. So began the independently funded and famous Bell laboratories, designed so that its faculty could walk its outdoor paths, think great thoughts and perform solution-agnostic experiments. More Nobel Prizes were won by the faculty at that institution than all other private free-standing research facilities in the US. Imagine what it felt like to be hired by a powerful CEO of a company and being told spend all your time in idle curiosity. Yet without that level of trust in the very process of science itself, the development of radio astronomy, the transistor, the laser, the photovoltaic cell, the charge-coupled device, information theory, the Unix operating system, and several programming languages would not have occurred. This approach led to eleven Nobel Prizes and five Turing Awards.
This story illustrates that a key element of success in research is the recognition of the value that idle curiosity brings to a scientific project. It is inefficient and costs money, time and resources. Yet without it, the foundational knowledge needed to drive innovation cannot emerge. The CEO of AT&T’s idea to let “scientific inquiry run its natural course” was not only visionary but demonstrated his trust in scientists and the process of science itself. And remember science is a process, not a result and is “true whether you believe it or not”, to quote Neil deGrasse Tyson.

10 March 2025
Comment on: Risk factors and protective measures for desmoid tumours in familial adenomatous polyposis: retrospective cohort study

Comment on: Risk factors and protective measures for desmoid tumours in familial adenomatous polyposis: retrospective cohort study

Davide Serrano, Lucio Bertario

Correspondence to: Dr. Davide Serrano (email: davide.serrano@ieo.it)
Division of Cancer Prevention and Genetics
European Insitute of Oncology

7 February 2025
Oesophageal cancer awareness month 2025

Oesophageal cancer awareness month 2025

Matthew Lee PhD FRCS

It is becoming increasingly common to dedicate days, or even months, to ‘health awareness’. These events should help people to learn about these conditions. From these, we can hope that people might learn about symptoms that help them get a diagnosis, or learn about new treatment options for their conditions. It also provides a focal point where we can come together as a community to recognise those impacted, and find ways to address these serious health conditions. It may even act as a clarion call, moving charities, governments, and individuals, to make efforts to fund and deliver research to further understand and improve outcomes for these conditions.
The BJS Academy, alongside BJS & BJS Open, feel it is an important part of our mission to contribute to these awareness months. So much research is published with enthusiasm, but then resides solely within the pages of a journal (or latterly, as a lonely PDF on a server). It is important to ensure that new information is shared with people who might find it useful. This is particularly important when it comes to conditions which currently have a poor prognosis, or may affect only a small number of people. With this in mind, our team will contribute to the online discussion for disease months by highlighting 2-3 papers from BJS and BJS Open, and sharing them across our social media channels. This will include a short summary and a link to the paper.
This move comes as part of our commitment to sharing key clinical research to support the knowledge of surgeons around the world, and to ensure our patients receive care informed by evidence of the highest possible standard.

5 February 2025