BJS Open

BJS Open is an #openaccess journal from @bjsurgery foundation and @BJSAcademy, featuring high-quality #surgicalresearch, Impact Factor of 4.5 (2024)

[BJS Open @BjsOpen]

Multicentre parallel-group open-label non-inferiority randomized clinical trial of recooling versus no recooling after normothermic machine perfusion in liver transplantation: ARANMP-LT protocol
➡️https://t.co/aIHl6WwH0Y

Liver grafts are frequently recooled before implantation after normothermic machine perfusion, although this step has never been evaluated in a randomized setting and temperature cycling may contribute to graft injury. This protocol describes ARANMP-LT, an investigator-initiated, open-label, parallel-group non-inferiority randomized clinical trial at multiple Italian centres. Adult recipients of machine-perfused deceased-donor livers will be randomized 1:1 to a portal flush with 5% albumin at 20–25°C without cold exposure or a cold preservation solution flush. The primary outcome is freedom from early allograft dysfunction within 7 days, with 170 patients planned.

👏👏👏Salvatore Gruttadauria, Roberta Vella, Fabrizio Di Francesco, Duilio Pagano, Marco Barbara, Monica Rizzo, Ivan Vella, Sergio Calamia, Alessandro Tropea, Pasquale Bonsignore, Caterina Accardo, Gaetano Burgio, Enzo Andorno, Marco Miggino, Stefania Camagni, Domenico Pinelli, Amedeo Carraro, Alex Borin, Matteo Cescon, Matteo Serenari, Umberto Cillo, Jacopo Lanari, Fabrizio Di Benedetto, Paolo Magistri, Giuseppe Maria Ettorre, Sara Ingallinella, Francesco Frongillo, Marco Maria Pascale, Davide Ghinolfi, Giulia Cirillo, Fabio Melandro, Gianluca Mennini, Francesco Tandoi, Irene Scalera, Giuseppe Tisone, Roberta Angelico, Marco Vivarelli, Federico Mocchegiani, Sergio Li Petri
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #protocol #RCT #livertransplant #HPBSurgery

[BJS Open @BjsOpen]

Chyme reinfusion using The Insides® System to reduce parenteral nutrition dependence in type 2 intestinal failure: multicentre randomized clinical trial (REINFUSE)
➡️https://t.co/MPFfGVCDjw

Type 2 intestinal failure due to double enterostomy or enterocutaneous fistula entails dependence on parenteral nutrition (PN), and chyme reinfusion therapy (CRT) has not been evaluated in a randomized trial. This trial randomized 39 PN-dependent adults at 12 UK and US centres 2 : 1 to device-assisted CRT plus standard care or standard care alone. At 30 days, 8 of 26 active participants (31%) achieved a ≥ 50% PN calorie reduction versus none of 13 controls (P = 0.035; prespecified threshold P < 0.025). At 60 days, 10 active participants had ceased PN, with an acceptable safety profile.

👏👏👏Tony Milne, Simon Lal, Arun Abraham, Kirstine Farrer, Jonathan Evans, Kathryn Thomas, Carolynne Vaizey, Simon Gabe, David Layfield, Neena Randhawa, John Rogers, David F Mercer, Liran Barda, Robert E Carroll, Martin D Rosenthal, Syed-Mohammed Jafri, Chris Frampton, Dermot Burke
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #RCT #EvidenceBasedSurgery #IntestinalFailure

[BJS Open @BjsOpen]

Survival impact of involvement of lymph node stations 16b1, 9, and 8a during pancreatoduodenectomy for pancreatic and periampullary cancers (PANODE): prospective multicentre study
➡️https://t.co/j8538RZmQa

Guidelines do not recommend routine sampling of lymph node stations (LNS) 16b1, 9, and 8a during pancreatoduodenectomy, as prospective multicentre data have been lacking. This prospective multicentre cohort study included 1218 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma (n = 673), distal cholangiocarcinoma, ampullary cancer, or duodenal cancer between 2015 and 2020. LNS 16b1 involvement was associated with worse overall survival across all four diagnoses, with an adjusted hazard ratio of 2.33 (95% c.i. 1.62 to 3.35) in pancreatic ductal adenocarcinoma. The authors propose that future studies assess routine preoperative and intraoperative LNS 16b1 sampling.

👏👏👏J Annelie Suurmeijer, Bobby K Pranger, Leonard W F Seelen, Mahsoem Ali, L Bengt van Rijssen, Dorine S Tseng, Tara M Mackay, Jacob L van Dam, Hjalmar C van Santvoort, Bas Groot Koerkamp, Arantza Farina Sarasqueta, Casper H van Eijck, Mike S L Liem, Geert Kazemier, Vincent B Nieuwenhuijs, Ignace H de Hingh, Joost M Klaase, Joris I Erdmann, Olivier R Busch, I Quintus Molenaar, Vincent E de Meijer, @MarcBesselink , on behalf of the Dutch Pancreatic Cancer Group
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #SurgicalOncology

[BJS Open @BjsOpen]

Early inflammatory signal in late-diagnosed anastomotic leakage after anterior resection
➡️https://t.co/eFx9gZ2Dwm

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

[BJS Open @BjsOpen]

Rationale and design of the SENTRY trial: sentinel node and organ-preserving surgery versus segmental resection in stage I colon cancer
➡️https://t.co/h7o4ngKxb8

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

[BJS Open @BjsOpen]

Revisiting lymphatic dissemination in gastric cancer: insights from a large Western multicentre cohort
➡️https://t.co/DM40MWKHKl

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

[BJS Open @BjsOpen]

Long-term oncological outcomes after nipple-sparing mastectomy and implant-based immediate breast reconstruction in a population-based cohort of breast cancer patients
➡️https://t.co/csf1fO1fas

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

[BJS Open @BjsOpen]

Elective cholecystectomy benchmarks: nationwide registry study
➡️https://t.co/s4QlnLqwrI

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

[BJS @BJSurgery]

Restorative resection in robot-assisted versuslaparoscopic total mesorectal excision: systematic review and meta-analysis
➡️ https://t.co/AUX5GpqorK

R-TME is associated with a higher likelihood of primary anastomosis formation while maintaining a comparable safety profile
The more pronounced effect in recent studies likely reflects increasing surgical expertise

Work by Charlotte M S Genders , Jory Wentink , Ritch T J Geitenbeek , Roel Hompes , Jasper B van Praagh , Esther C J Consten

#SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology
#Some4COLoprocto

[BJS @BJSurgery]

Standard reporting on duodenal stump leakage after gastric cancer resections: multicentre analysis from the GASTRODATA Study Group (the STARDUST study)
➡️ https://t.co/Fb0Pbjjm1y

Postoperative DSL was uncommon (2.6%), but it was associated with a 90-day mortality rate of 17.2%, which varied according to the severity of the clinical presentation and the invasiveness of the treatment
Preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion were prognostic factors associated with complication occurrence.

Work by Mattia Molteni , Francesco Puccetti , Gian Luca Baiocchi , Guillaume Piessen , William Allum , Andrew Davies , Arnulf Hoelscher , Ines Gockel , Daniel Reim , Paolo Morgagni , Uberto Fumagalli Romario , Domenico D’Ugo , Rossella Reddavid , Giovanni De Manzoni , Johanna van Sandick , Suzanne Gisbertz , Bas Wijnhoven , Wojciech Polkowski , Piotr Kołodziejczyk , Wojciech Kielan , Paulo Matos da Costa , Lucio Lara Santos , Manuel Pera , Stefan Moenig , Paul M Schneider , Christian A Gutschow , Ugo Elmore , Riccardo Rosati , Other Members of the GASTRODATA Study Group

#SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial @YoungIFSO #bariatricsurgery

[BJS Open @BjsOpen]

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
➡️https://t.co/BzoNK2egFe

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

[BJS Open @BjsOpen]

Association between preoperative physical exercise and the risk of postoperative venous thromboembolism: nationwide population-based cohort study
➡️https://t.co/N20ySXn5GX

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

[BJS Open @BjsOpen]

Outpatient non-operative treatment of uncomplicated acute appendicitis: meta-analysis ➡️https://t.co/XzRKcDJRVM

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

[BJS Open @BjsOpen]

Methodological challenges in surgical randomized trials: systematic review of rectal cancer studies
➡️https://t.co/G6LK23BZRM

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

[BJS Open @BjsOpen]

Costs and health burden of surgical site infections and anastomotic leakage in major abdominal surgery
➡️https://t.co/jKwE1XXnRc

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

[BJS Open @BjsOpen]

Role of circulating tumour DNA in predicting complete clinical response and local regrowth after total neoadjuvant therapy for rectal cancer: meta-analysis
➡️https://t.co/OAfPh6HSjh

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

[BJS Academy @BJSAcademy]

The Foundation provides a variety of benefits through its collaborations with strategic partners and partners.

In 2021, the Charity Committee was established to manage important causes the Foundation would like to support that do not fit into this model, playing a key role in its overarching mission.

You can apply for funding on the https://t.co/xKNBqLMh7O website
➡️https://t.co/ZpXUJaFpZm

[BJS Academy @BJSAcademy]

You’ve just told a patient they need surgery. How much of the conversation will they actually remember?

Often, not nearly enough.

A simple Question Prompt List could help change that.

The POWER form improved patient recall by 56%, supported shared decision-making and reduced decisional conflict — without making clinic appointments longer.

Simple. Low-cost. Practical.

👉 Read the new BJS Academy blog:
https://t.co/rT9diMN9pt
#PatientCommunication #SharedDecisionMaking #Surgery #PatientCare #BJSAcademy

[BJS Academy @BJSAcademy]

🏆 RCT of the Month
Can a duodenal-jejunal bypass liner improve diabetes control and weight loss in people with obesity — without surgery?

In this multicentre, double-blind, sham-controlled trial of 320 patients, the EndoBarrier group achieved greater reductions in HbA1c and significantly more weight loss at 12 months than the sham group.
📉 HbA1c: −1.10% vs −0.28%
⚖️ Total weight loss: 7.7% vs 2.1%
🎯 HbA1c ≤7%: 28.3% vs 9.4%
However, 9.4% experienced device-related serious adverse events, highlighting an important balance between efficacy and safety.

🗨️ “A rare, well-run sham-controlled device trial with a clean efficacy signal, though important risk of device-related adverse events.”
— Jenny Moon, MD

➡️ Read the full RCT of the Month:
https://t.co/HOlVBfRp6v
#RCTOfTheMonth #Type2Diabetes #Obesity #MetabolicSurgery #SurgicalResearch #BJSAcademy

[BJS Academy @BJSAcademy]

Writing a paper? Reviewing one? Trying to get published?

You do not have to figure it all out on your own.

BJS Academy has brought together a collection of free educational resources covering the whole research and publishing journey — from designing studies and writing your first manuscript to peer review, editing and promoting your work after publication.

Learn directly from BJS and BJS Open editors, researchers, statisticians and publishing experts.
✍️ Writing
📊 Research methods
🔎 Peer review
📝 Editing
📚 Publishing
And it is all freely available.

👉 Bookmark the collection:
https://t.co/wgb4QYUQ2G

#SurgicalResearch #AcademicSurgery #MedicalWriting #SurgicalEducation #BJSAcademy #surgery #writing #reviewing #surgicalwriting #surgicalpublising #medical #education #medicaleducation #surgicaleducation