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Results in Journal British Journal of Surgery: 39,048

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, Z Madrazo, S Videla, B Sainz, A Rodríguez-González, A Campos, M Santamaría, A Pelegrina, C González-Serrano, A Aldeano, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab299

Abstract:
Background Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. Methods Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. Results Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. Conclusion Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.
, A F J M Heldens, M J L Bours, N L U van Meeteren, L P S Stassen, T Lubbers,
British Journal of Surgery; https://doi.org/10.1093/bjs/znab292

Abstract:
Steep ramp test (SRT) performance provides an estimation of preoperative aerobic fitness that is associated with postoperative outcomes. Patients with a better SRT-estimated aerobic fitness are less likely to develop postoperative complications and more likely to experience a shorter time to recovery. The SRT might be a useful and clinically accessible tool in preoperative risk assessment to identify patients at risk of postoperative morbidity and who might benefit from preoperative exercise interventions.
E Back, J Häggström, , M M Haapamäki, P Matthiessen, J Rutegård
British Journal of Surgery; https://doi.org/10.1093/bjs/znab260

Abstract:
Background A permanent stoma after anterior resection for rectal cancer is common. Preoperative counselling could be improved by providing individualized accurate prediction modelling. Methods Patients who underwent anterior resection between 2007 and 2015 were identified from the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine presence of a stoma 2 years after surgery. A training set based on the years 2007–2013 was employed in an ensemble of prediction models. Judged by the area under the receiving operating characteristic curve (AUROC), data from the years 2014–2015 were used to evaluate the predictive ability of all models. The best performing model was subsequently implemented in typical clinical scenarios and in an online calculator to predict the permanent stoma risk. Results Patients in the training set (n = 3512) and the test set (n = 1136) had similar permanent stoma rates (13.6 and 15.2 per cent). The logistic regression model with a forward/backward procedure was the most parsimonious among several similarly performing models (AUROC 0.67, 95 per cent c.i. 0.63 to 0.72). Key predictors included co-morbidity, local tumour category, presence of metastasis, neoadjuvant therapy, defunctioning stoma use, tumour height, and hospital volume; the interaction between age and metastasis was also predictive. Conclusion Using routinely available preoperative data, the stoma outcome at 2 years after anterior resection for rectal cancer can be predicted fairly accurately.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab298

Abstract:
A 14-year-old female presented with progressive abdominal distension and constipation. An MRI was performed and the patient taken to the operating theatre. What is the diagnosis from these intra-operative images
B P Müller-Stich, , H Nienhüser, S Fazeli, J Senft, E Kalkum, P Heger, R Warschkow, , A T Billeter, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab278

Abstract:
Background Minimally invasive oesophagectomy (MIO) for oesophageal cancer may reduce surgical complications compared with open oesophagectomy. MIO is, however, technically challenging and may impair optimal oncological resection. The aim of the present study was to assess if MIO for cancer is beneficial. Methods A systematic literature search in MEDLINE, Web of Science and CENTRAL was performed and randomized controlled trials (RCTs) comparing MIO with open oesophagectomy were included in a meta-analysis. Survival was analysed using individual patient data. Random-effects model was used for pooled estimates of perioperative effects. Results Among 3219 articles, six RCTs were identified including 822 patients. Three-year overall survival (56 (95 per cent c.i. 49 to 62) per cent for MIO versus 52 (95 per cent c.i. 44 to 60) per cent for open; P = 0.54) and disease-free survival (54 (95 per cent c.i. 47 to 61) per cent versus 50 (95 per cent c.i. 42 to 58) per cent; P = 0.38) were comparable. Overall complication rate was lower for MIO (odds ratio 0.33 (95 per cent c.i. 0.20 to 0.53); P < 0.010) mainly due to fewer pulmonary complications (OR 0.44 (95 per cent c.i. 0.27 to 0.72); P < 0.010), including pneumonia (OR 0.41 (95 per cent c.i. 0.22 to 0.77); P < 0.010). Conclusion MIO for cancer is associated with a lower risk of postoperative complications compared with open resection. Overall and disease-free survival are comparable for the two techniques.
D J Park, Y -W Kim, , K W Ryu, S -U Han, , , J H Park, Y -S Suh, O K Kwon, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab295

Abstract:
Background There remain concerns about the safety and functional benefit of laparoscopic pylorus-preserving gastrectomy (LPPG) compared with laparoscopic distal gastrectomy (LDG). This study evaluated short-term outcomes of a randomized clinical trial (RCT) comparing LPPG with LDG for gastric cancer. Methods The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial was an investigator-initiated, open-label, parallel-assigned, superiority, multicentre RCT in Korea. Patients with cT1N0M0 cancer located in the middle third of the stomach at least 5 cm from the pylorus were randomized to undergo LPPG or LDG. Participants, care givers and those assessing the outcomes were not blinded to group assignment. Outcomes were 30-day postoperative morbidity rate and death at 90 days. Results Some 256 patients from nine institutions were randomized (LPPG 129 patients, LDG 127 patients) between July 2015 and July 2017 and outcomes for 253 patients were analysed. Postoperative complications within 30 days were seen in 19.3 and 15.5 per cent in the LPPG and LDG groups respectively (P = 0·419). Postoperative pyloric stenosis was observed in nine (7.2 per cent) and two (1·5 per cent) patients in the LPPG and LDG groups (P = 0·026) respectively. In multivariable analysis higher BMI was a risk factor for postoperative complications (odds ratio 1·17, 95 per cent c.i. 1·04 to 1·32; P = 0·011). Death at 90 days was zero in both groups. Conclusion Postoperative complications and mortality was comparable in patients undergoing LPPG and LDG. Registration number: NCT02595086 (http://www.clinicaltrials.gov).
British Journal of Surgery; https://doi.org/10.1093/bjs/znab244

Abstract:
Communication with surgeons is vital for the advancement of surgery. Surgeons should learn to appropriately use communication technologies to improve information sharing.
I Alkatout, B Holthaus, C Bozzaro, T Wedel, A M Westermann, L Mettler, K -P Jünemann, T Becker, N Maass, J Ackermann
British Journal of Surgery; https://doi.org/10.1093/bjs/znab297

Abstract:
Based on the principles of biomedical ethics, the authors conducted a survey focusing on the ethical aspects of, didactic benefits of and possible alternatives to live surgery events. This work provides an investigation of the ethics of live surgery events in an interdisciplinary and multicentre setting. Critical ethical concerns regarding the justification of such events are highlighted through evaluation of attendees and surgeons.
E L Vos, R A Carr, M Hsu, M Nakauchi, T Nobel, A Russo, A Barbetta, K S Tan, L Tang, D Ilson, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab228

Abstract:
Background Trials typically group cancers of the gastro-oesophageal junction (GOJ) with oesophageal or gastric cancer when studying neoadjuvant chemoradiation and perioperative chemotherapy, so the results may not be fully applicable to GOJ cancer. Because optimal neoadjuvant treatment for GOJ cancer remains controversial, outcomes with neoadjuvant chemoradiation versus chemotherapy for locally advanced GOJ adenocarcinoma were compared retrospectively. Methods Data were collected from all patients who underwent neoadjuvant treatment followed by surgery for adenocarcinoma located at the GOJ at a single high-volume institution between 2002 and 2017. Postoperative major complications and mortality were compared between groups using Fisher’s exact test. Overall survival (OS) and disease-free survival (DFS) were assessed by log rank test and multivariable Cox regression analyses. Cumulative incidence functions were used to estimate recurrence, and groups were compared using Gray’s test. Results Of 775 patients, 650 had neoadjuvant chemoradiation and 125 had chemotherapy. These groups were comparable in terms of clinical tumour and lymph node categories, although the chemoradiation group had greater proportions of white men, complete pathological response to chemotherapy, and smaller proportions of diffuse cancer, poor differentiation, and neurovascular invasion. Postoperative major complications (20.0 versus 17.6 per cent) and 30-day mortality (1.7 versus 1.6 per cent) were not significantly different between the chemoradiation and chemotherapy groups. After adjustment, type of therapy (chemoradiation versus chemotherapy) was not significantly associated with OS (hazard ratio (HR) 1.26, 95 per cent c.i. 0.96 to 1.67) or DFS (HR 1.27, 0.98 to 1.64). Type of recurrence (local, regional, or distant) did not differ after neoadjuvant chemoradiation versus chemotherapy. Conclusion In patients undergoing surgical resection for locally advanced adenocarcinoma of the GOJ, OS and DFS did not differ significantly between patients who had neoadjuvant chemoradiation compared with chemotherapy.
N Granchi, , K P Foley, J L Reid, T D Vreugdenburg, M I Trochsler, M H Bruening, G J Maddern
British Journal of Surgery; https://doi.org/10.1093/bjs/znab283

Abstract:
Introduction The lack of an effective continuing professional development programme for qualified surgeons, specifically one that enhances non-technical skills (NTS), is an issue receiving increased attention. Peer-based coaching, used in multiple professions, is a proposed method to deliver this. The aim of this study was to undertake a systematic review of the literature to summarize the quantity and quality of studies involving surgical coaching of NTS in qualified surgeons. Methods A systematic search of the literature was performed through MEDLINE, EMBASE, Cochrane Collaboration and PsychINFO. Studies were selected based on predefined inclusion and exclusion criteria. Data for the included studies was independently extracted by two reviewers and the quality of the studies evaluated using the Medical Education and Research Study Quality Instrument (MERSQI). Results Some 4319 articles were screened from which 19 met the inclusion criteria. Ten studies involved coaching of individual surgeons and nine looked at group coaching of surgeons as part of a team. Group coaching studies used non-surgeons as coaches, included objective assessment of NTS, and were of a higher quality (average MERSQI 13.58). Individual coaching studies focused on learner perception, used experienced surgeons as coaches and were of a lower quality (average MERSQI 11.58). Individual coaching did not show an objective improvement in NTS for qualified surgeons in any study. Conclusion Surgical coaching of qualified surgeons’ NTS in a group setting was found to be effective. Coaching of individual surgeons revealed an overall positive learner perception but did not show an objective improvement in NTS for qualified surgeons.
A P Lin, T -W Huang,
British Journal of Surgery; https://doi.org/10.1093/bjs/znab279

Abstract:
Background Breast cancer is rare in men and managed by extrapolating from breast cancer in women. The clinicopathological features of male breast cancer, however, differ from those of female breast cancer. Because clinical trials are rare, the synthesis of real-world data is one method of integrating sufficient evidence on the optimal treatment for this patient population. Methods PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they evaluated the treatments of interest in male breast cancer; these evaluations included breast-conserving surgery (BCS) versus mastectomy, postmastectomy radiation therapy versus no radiation, the accuracy of sentinel lymph node biopsy (SLNB), and a comparison of various endocrine therapies. Results Forty studies were retrieved. The pooled estimate of overall survival (OS) revealed no difference between BCS and mastectomy groups. Postmastectomy radiation to the chest wall significantly increased OS relative to no postmastectomy radiation (hazard ratio (HR) 0.67, 95 per cent confidence interval 0.54 to 0.84). The pooled estimates of identification and false-negative rates of SLNB were 97.4 and 7.4 per cent respectively. Tamoxifen treatment was associated with significantly increased OS compared with no tamoxifen intake (HR 0.62, 0.41 to 0.95). Conclusion Identification and false-negative rates for SLNB were comparable to those in female breast cancer. Breast-conserving surgery can be effective and safe; postmastectomy radiation to the chest wall and 5-year tamoxifen treatment improves survival.
, J V Reynolds
British Journal of Surgery; https://doi.org/10.1093/bjs/znab210

Abstract:
Morbidity and impacts on quality of life remain significant issues following oesophagectomy for oesophageal cancer. This paper reviews and weighs the current evidence both in favour of and against the adoption of an organ-preserving approach in patients with a complete clinical response to neoadjuvant therapy.
O B van Leeuwen, R J Porte
British Journal of Surgery; https://doi.org/10.1093/bjs/znab293

Abstract:
Hypothermic oxygenated machine perfusion (HOPE) reduces ischaemia–reperfusion injury of donor livers and thereby improves outcomes after transplantation. End-ischaemic normothermic machine perfusion (NMP) enables assessment of hepatobiliary viability and selection of livers that would otherwise have been declined for transplantation. We advocate the combined use of (dual) HOPE and NMP for livers that are considered high risk, but may still be transplanted safely after ex situ resuscitation and assessment of hepatobiliary viability. Combined dual HOPE–NMP has the potential to substantially decrease the high rates of deceased donor liver discard.
, V Bellato, J M Carvas, C D Córdoba, D Daudu, J Dziakova, K Eltarhoni, N El Feituri, A C H Fung, C Fysaraki, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab275

Abstract:
Background There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work–life balance globally. Methods A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. Results Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work–life balance. Conclusion Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.
, A N S Silva, , S King, N Torpey, , , F J Rouhani
British Journal of Surgery; https://doi.org/10.1093/bjs/znab223

Abstract:
Lay Summary During a kidney transplant, a plastic tube (stent) is placed in the ureter, connecting the new kidney to the bladder, in order to keep the new join open during the initial phase of transplantation. The stent is then removed after a few weeks via a camera procedure (cystoscopy), as it is no longer needed. The present study compared performing this in the operating theatre or in clinic for transplanted patients using a new single-use type of camera with an integrated grasper system. The results have shown that it is safe and cost-effective to do this in clinic, despite patients being susceptible to infection after transplantation.
, D Brinkman, D L James, S O’Neill, C Murphy, I O’Riordan, G O’Flanagan, B Lang, I Keogh, E Lang, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab266

Abstract:
Real-time polymerase chain reaction (RT-PCR) is used to rule out SARS-CoV-2 prior to surgery, however few studies have evaluated patients with negative testing after surgery. Some 499 patients with negative tests were followed for 14 days after surgery, 39 were retested but none developed positive RT-PCR after operation. The risk of developing a positive RT-PCR after surgery was 0.74 per cent.
K Motomura, Y Tabuchi, Y Enomoto, T Nishida, T Nakaoka, D Mori, M Kouda
British Journal of Surgery; https://doi.org/10.1093/bjs/znab277

Abstract:
Superparamagnetic iron oxide (SPIO)-enhanced MRI at 1.5 T with fat-suppression sequence is useful for the detection of metastases in sentinel nodes localized by CT lymphography in patients with breast cancer. SPIO-enhanced MRI may offer an alternative to sentinel node biopsy and avoid axillary surgery itself for patients with breast cancer who have negative sentinel nodes on SPIO-enhanced MRI.
C Boffa, , S Vig, S R Knight, E Royston, I Quiroga, S Sinha
British Journal of Surgery; https://doi.org/10.1093/bjs/znab276

Abstract:
Sexual harassment exists within the surgical training community and environment. This is unprofessional behaviour and the surgical community must raise awareness of it as well as facilitating and encouraging reporting with robust investigation pathways.
H Ueo, I Minoura, A Gamachi, T Doi, M Yamaguchi, T Yamashita, H Tsuda, T Moriya, Y Kozuka, T Sasaki, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab265

Abstract:
In both 5- and 15-min data, FI was significantly higher in malignant tissues than in benign tissues. The diagnostic accuracy was similar at 5 and 15 min. Therefore, the 5-min FI was enough applying in the further analyses.
H Tibermacine, , M Sbarra, R Forghani, C Reinhold,
British Journal of Surgery; https://doi.org/10.1093/bjs/znab191

Abstract:
Background Radiomics may be useful in rectal cancer management. The aim of this study was to assess and compare different radiomics approaches over qualitative evaluation to predict disease-free survival (DFS) in patients with locally advanced rectal cancer treated with neoadjuvant therapy. Methods Patients from a phase II, multicentre, randomized study (GRECCAR4; NCT01333709) were included retrospectively as a training set. An independent cohort of patients comprised the independent test set. For both time points and both sets, radiomic features were extracted from two-dimensional manual segmentation (MS), three-dimensional (3D) MS, and from bounding boxes. Radiomics predictive models of DFS were built using a hyperparameters-tuned random forests classifier. Additionally, radiomics models were compared with qualitative parameters, including sphincter invasion, extramural vascular invasion as determined by MRI (mrEMVI) at baseline, and tumour regression grade evaluated by MRI (mrTRG) after chemoradiotherapy (CRT). Results In the training cohort of 98 patients, all three models showed good performance with mean(s.d.) area under the curve (AUC) values ranging from 0.77(0.09) to 0.89(0.09) for prediction of DFS. The 3D radiomics model outperformed qualitative analysis based on mrEMVI and sphincter invasion at baseline (P = 0.038 and P = 0.027 respectively), and mrTRG after CRT (P = 0.017). In the independent test cohort of 48 patients, at baseline and after CRT the AUC ranged from 0.67(0.09) to 0.76(0.06). All three models showed no difference compared with qualitative analysis in the independent set. Conclusion Radiomics models can predict DFS in patients with locally advanced rectal cancer.
, S Phillips, R Rai, P Corke
British Journal of Surgery; https://doi.org/10.1093/bjs/znab269

Abstract:
This article is a response to the publication ‘Comparison of multimodal analgesia with thoracic epidural after transthoracic oesophagectomy’. It discuss the differing outcomes from using this technique in other publications.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab262

Abstract:
A 32-year-old woman presented with pain and numbness in the right leg. Radiological imaging and subsequent core biopsy diagnosed a large sciatic notch “dumbbell-shaped” lipoma measuring 17cm. What is the surgeon doing and why?
J E Rosen, N Agrawal, D R Flum, J M Liao
British Journal of Surgery; https://doi.org/10.1093/bjs/znab280

Abstract:
A randomized survey of 1257 respondents was used to assess willingness to undergo antibiotic treatment of appendicitis with different quoted risks of treatment failure requiring appendicectomy. Overall, 1045 respondents (83.1 per cent) were willing to try antibiotics. Even at a quoted 60 per cent risk of failure, 75 per cent of respondents were willing to attempt antibiotic treatment.
Corrigendum
Maxwell D Mirande, Matthew C Hernandez, David M Nagorney
British Journal of Surgery; https://doi.org/10.1093/bjs/znab302

Abstract:
Br J Surg 2021; 108: 701. DOI: 10.1093/bjs/znab126
Woohyung Lee, Minyoung Oh, Jae Seung Kim, , Jae Woo Kwon, Eunsung Jun, , Jae Hoon Lee, Dae Wook Hwang, Changhoon Yoo, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab229

Abstract:
Background The optimal prognostic markers for neoadjuvant chemotherapy in patients with borderline resectable or locally advanced pancreatic cancer are not yet established. Method Patients who received neoadjuvant chemotherapy prior to surgery and underwent FDG-PET/CT between July 2012 and December 2017 were included. Metabolic parameters including standardised uptake value (SUV), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) on PET/CT, and response evaluations using PERCIST criteria, were investigated for its impact on survival and recurrence. Cox proportional hazards model was performed. Differences in risk were expressed as hazard ratio [HR] with 95% confidence interval [c.i.]. Results The patients with borderline resectable (N = 106) or locally advanced pancreatic cancer (N = 82) were identified. The median survival was 33.6 months. Decreased metabolic parameters of PET/CT after neoadjuvant chemotherapy were associated with positive impacts on survival and recurrence such as SUVmax (HR 1.16, 95% c.i. 1.01 to 1.32, P = 0.025), SUVpeak (HR 1.26, 95% c.i. 1.05 to 1.51, P = 0.011), and MTV (HR 1.15, 95% c.i. 1.04 to 1.26, P = 0.005). Large delta values were related to a positive impact on recurrence such as SUVmax (HR 1.21, 95% c.i. 1.06 to 1.38, P = 0.005). Post-neoadjuvant chemotherapy SUVmax ≥3 (HR 3.46, 95% c.i. 1.21 to 9.91; P = 0.036) was an independent prognostic factor for negative impact on survival. Patients with post-neoadjuvant chemotherapy SUVmax <3 showed more chemotherapy cycles (8.7 versus 6.2, P = 0.001), more frequent complete metabolic response (25 vs 2.2%, P = 0.002), smaller tumour size (2.1 vs 3.1 cm, P = 0.002), and less frequent lymphovascular invasion (23.7 vs 51.1%, P = 0.020) than patients with SUVmax ≥3. Conclusion Reduction in metabolic tumour parameters of FDG- PET/CT after neoadjuvant chemotherapy indicates improved overall survival and recurrence-free survival.
, , T Qiu, C Robinson, C Bertschy, A C Arroliga, W Peters
British Journal of Surgery; https://doi.org/10.1093/bjs/znab216

Abstract:
This research letter details the safety of a universal asymptomatic preprocedural SARS-CoV-2 testing protocol implemented within a large, integrated healthcare system. Among over 145 000 tests administered, fewer than 1 in 1000 patients had subsequent positive tests within 10 days of an initial negative SARS-CoV-2 test. Despite the infrequency of positive tests after negative screening tests, patient-to-provider transmission was documented in five instances.
A Koh, R M Parks, A Courtney, D R Leff, on behalf of the MAMMA Steering Committee
British Journal of Surgery; https://doi.org/10.1093/bjs/znab155

, , M L W Rutgers, R M P H Crolla, N A W Van Geloven, R Hompes, J W A Leijtens, F Polat, A Pronk, A B Smits, et al.
British Journal of Surgery; https://doi.org/10.1093/bjs/znab233

Abstract:
Background Laparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced morbidity. However, comparative data between the three approaches are lacking. The aim of this study was to compare short-term outcomes for laparoscopic TME, robot-assisted TME and TaTME in expert centres. Methods Patients undergoing rectal cancer surgery between 2015 and 2017 in expert centres for laparoscopic, robot-assisted or TaTME were included. Outcomes for TME surgery performed by the specialized technique in the expert centres were compared after propensity score matching. The primary outcome was conversion rate. Secondary outcomes were morbidity and pathological outcomes. Results A total of 1078 patients were included. In rectal cancer surgery in general, the overall rate of primary anastomosis was 39.4, 61.9 and 61.9 per cent in laparoscopic, robot-assisted and TaTME centres respectively (P < 0.001). For specialized techniques in expert centres excluding abdominoperineal resection (APR), the rate of primary anastomosis was 66.7 per cent in laparoscopic, 89.8 per cent in robot-assisted and 84.3 per cent in TaTME (P < 0.001). Conversion rates were 3.7 , 4.6 and 1.9 per cent in laparoscopic, robot-assisted and TaTME respectively (P = 0.134). The number of incomplete specimens, circumferential resection margin involvement rate and morbidity rates did not differ. Conclusion In the minimally invasive treatment of rectal cancer more primary anastomoses are created in robotic and TaTME expert centres.
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