British Journal of Surgery

Journal Information
ISSN / EISSN : 0007-1323 / 1365-2168
Published by: Oxford University Press (OUP) (10.1093)
Total articles ≅ 38,601
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B Essola, J Himpens, A Limgba, J Landenne, D D Tamchom, E Ngaroua, , E T Mboudou, , M P Hermans, et al.
British Journal of Surgery; doi:10.1093/bjs/znab188

B Görgec, R S Fichtinger, , , M J Van der Poel, R Al-Jarrah, T Armstrong, , Å A Fretland, A Suhool, et al.
British Journal of Surgery; doi:10.1093/bjs/znab096

Abstract:
Background Based on excellent outcomes from high-volume centres, laparoscopic liver resection is increasingly being adopted into nationwide practice which typically includes low-medium volume centres. It is unknown how the use and outcome of laparoscopic liver resection compare between high-volume centres and low-medium volume centres. This study aimed to compare use and outcome of laparoscopic liver resection in three leading European high-volume centres and nationwide practice in the Netherlands. Method An international, retrospective multicentre cohort study including data from three European high-volume centres (Oslo, Southampton and Milan) and all 20 centres in the Netherlands performing laparoscopic liver resection (low-medium volume practice) from January 2011 to December 2016. A high-volume centre is defined as a centre performing >50 laparoscopic liver resections per year. Patients were retrospectively stratified into low, moderate- and high-risk Southampton difficulty score groups. Results A total of 2425 patients were included (1540 high-volume; 885 low-medium volume). The median annual proportion of laparoscopic liver resection was 42.9 per cent in high-volume centres and 7.2 per cent in low-medium volume centres. Patients in the high-volume centres had a lower conversion rate (7.4 versus 13.1 per cent; P < 0.001) with less intraoperative incidents (9.3 versus 14.6 per cent; P = 0.002) as compared to low-medium volume centres. Whereas postoperative morbidity and mortality rates were similar in the two groups, a lower reintervention rate (5.1 versus 7.2 per cent; P = 0.034) and a shorter postoperative hospital stay (3 versus 5 days; P < 0.001) were observed in the high-volume centres as compared to the low-medium volume centres. In each Southampton difficulty score group, the conversion rate was lower and hospital stay shorter in high-volume centres. The rate of intraoperative incidents did not differ in the low-risk group, whilst in the moderate-risk and high-risk groups this rate was lower in high-volume centres (absolute difference 6.7 and 14.2 per cent; all P < 0.004). Conclusion High-volume expert centres had a sixfold higher use of laparoscopic liver resection, less conversions, and shorter hospital stay, as compared to a nationwide low-medium volume practice. Stratification into Southampton difficulty score risk groups identified some differences but largely outcomes appeared better for high-volume centres in each risk group.
British Journal of Surgery; doi:10.1093/bjs/znab159

Abstract:
Organ preservation is a hot topic in rectal cancer management. With the increasing number of trials now reporting success with organ preservation in early and locally advanced rectal cancer, this short review considers how organ preservation will continue to integrate into clinical practice and what this will mean for rectal cancer surgeons.
British Journal of Surgery; doi:10.1093/bjs/znab235

Abstract:
A 45 year old woman presented with decreased mouth opening, foul smell from the oral cavity, and chain of nodular swellings over chin, neck, chest region since three months. These had increased in size and number since one month. Also, dimpling over her left cheek and scar mark over her neck and chin region was noted. What is the diagnosis?
, A Hughes, P B White, M A Silva
British Journal of Surgery; doi:10.1093/bjs/znab221

Abstract:
The impact of acute pancreatitis in pregnancy on maternal and fetal outcomes is unclear. Historical case series document very poor outcomes, with maternal mortality rates of 20 per cent and fetal loss of 50 per cent. However, this is based on outdated clinical practice. This meta-analysis quantified both maternal and fetal outcomes following acute pancreatitis in pregnancy based on the concurrent literature. Maternal and fetal outcomes after acute pancreatitis in pregnancy have improved with advances in the management of pancreatitis.
British Journal of Surgery; doi:10.1093/bjs/znab250

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