Defining absolute postoperative desmoid risk in familial adenomatous polyposis according to APC genotype and family history: retrospective cohort study ➡️doi.org/10.1093/bjsopen/zrag… Desmoid disease is a major cause of morbidity and mortality after prophylactic colorectal surgery in familial adenomatous polyposis (FAP), yet absolute risk estimates are lacking. This retrospective registry-based cohort study quantifies absolute postoperative desmoid risk according to APC genotype and first-degree family history of desmoid. Among 48 patients with pathogenic variants 3′ of codon 1399, desmoid developed in 80% with a family history versus 15% without; among 1213 patients with variants at or 5′ of codon 1399, rates were 30% versus 10%. Without a family history, risk appeared relatively low irrespective of genotype, supporting individualised perioperative counselling. 👏👏👏Benjamin Zare, Massih Bahar, Susan Clark, Andrew Latchford #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #HereditaryCancer #DesmoidTumor #Polyposis

Retrospective global cohort study of 2665 children defines the first outcome benchmarks for paediatric living donor liver transplantation ➡️doi.org/10.1093/bjsopen/zrag… Living donor liver transplantation (LDLT) expands the paediatric donor pool, but there are no standardized quality references for its technical complexity or for regional variation in outcomes. Recipients from 19 centres across five continents (2019–2023) were analysed, and benchmark cut-offs were derived from 1988 low-risk patients at seven high-volume centres. The thresholds include hepatic artery thrombosis ≤ 5%, bile leak ≤ 12%, biliary anastomotic stricture ≤ 6%, and 1-year graft loss and mortality ≤ 6% each. Higher centre volume was associated with fewer major complications, particularly biliary complications, and with lower failure-to-rescue rates. Grading with the Clavien–Madadi classification reclassified many Clavien–Dindo grade IIIb events as grade IIIa. The benchmarks provide a reference framework for surgical quality assessment and safe programme expansion. 👏👏👏Zhihao Li, Omid Madadi-Sanjani, Yuan Liu, Dimitri A Raptis, Vasanthakumar Gunasekaran, Ashwin Rammohan, Seisuke Sakamoto, Hajime Uchida, Piotr Kaliciński, Marek Stefanowicz, Nicolas Goldaracena, Cornelius J van Beekum, Felix J Krendl, Itsuko Chih-Yi Chen, Bryanna N Domenick, Alfred Kow, Kaihang Wang, Yuji Soejima, Katryn N Furuya, George V Mazariegos, Vidyadhar Padmakar Mali, Stephen C Dunn, Kim M Olthoff, Elizabeth B Rand, Ian Leipnitz, Chao-Long Chen, Deniz Balci, Elvan Onur Kirimker, Silvio Nadalin, Stefan Schneeberger, Debra L Sudan, Moritz Schmelzle, Uta Herden, Lutz Fischer, Blayne A Sayed, Vicky L Ng, Grzegorz Kowalewski, Mureo Kasahara, Mohamed Rela, Dieter C Broering, Qiang Xia, Pierre-Alain Clavien #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #LiverTransplant #LDLT #PaediatricSurgery #Transplantation #SurgicalQuality

Patient-initiated follow-up can reduce outpatient burden in selected surgical populations while maintaining patient-reported outcomes, although effects are context-dependent ➡️doi.org/10.1093/bjsopen/zrag… Rising outpatient demand has prompted adoption of patient-initiated follow-up (PIFU), in which clinically stable patients initiate contact when symptoms arise instead of attending scheduled appointments. This systematic review and meta-analysis synthesized 34 studies, comprising 4 randomized clinical trials, 17 observational cohort studies, 11 qualitative and 2 mixed-methods studies, across breast, colorectal, otorhinolaryngology, orthopaedic, plastic surgery and urology practice. Randomized trials reported comparable patient-reported quality of life with PIFU and standard follow-up, alongside fewer physician contacts in breast cancer (1.9 versus 3.8 consultations per patient over 2 years; P < 0.001) and rectal cancer. Across nine studies (1806 participants), the pooled proportion of patients initiating follow-up was 0.19 (95% CI 0.09 to 0.36; I² = 95%), indicating substantial context-dependent variation. Structured surveillance and rapid-access pathways were identified as critical safety adjuncts in oncological settings, where the authors propose risk-stratified or hybrid follow-up models. 👏👏👏Renato Pitesa, Stephanie Moody, Andrew G Hill #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #SystematicReview #MetaAnalysis #PIFU #SurgicalOncology #HealthServicesResearch

🆕 Unverifiable numerical reporting and eligibility judgements in a meta-analysis of incisional negative pressure wound therapy in breast surgery ➡️ buff.ly/vQarLBy

Rectus sheath catheters or thoracic epidural analgesia — which should we trust after open surgery? A recent systematic review prompted further debate, and the discussion is now continuing through a published comment and author response. Explore the arguments, the interpretation of the evidence, and what this means for postoperative pain management. 👉 Read both sides of the discussion: buff.ly/V6BOAyP Published in @BJSurgery

Splenic hilum nodal involvement is rare in resected left-sided pancreatic ductal adenocarcinoma, particularly in pancreatic body tumours ➡️doi.org/10.1093/bjsopen/zrag… Splenectomy is routinely performed during left pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) to achieve adequate lymphadenectomy, although supporting evidence is limited and splenic preservation may be relevant to emerging immunotherapies and personalized cancer vaccines. This PROSPERO-registered systematic review and meta-analysis included 22 studies comprising 2260 patients undergoing left pancreatectomy for PDAC. The pooled prevalence of splenic hilum nodal involvement (station 10) was 3.7% (95% c.i. 2.2% to 6.2%), with rates of 1.1% in pancreatic body and 9.7% in pancreatic tail tumours. Splenic artery nodal involvement (station 11) was identified in 39.1%, and splenic hilum involvement was not significantly associated with overall survival (pooled HR 2.05; 95% c.i. 0.89 to 4.73). Given the very low certainty of the available evidence, prospective studies are required to determine whether spleen preservation can be safely applied in selected patients. 👏👏👏Caro L Bruna, Charlotte E Baggerman van Houweninge, Faridi S Jamaludin, Guiseppe Malleo, Mohammad Abu Hilal, @MarcBesselink , Jony van Hilst #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #SurgicalOncology #MetaAnalysis

Global disparities in hepatocellular carcinoma outcomes: a multicentre study ➡️doi.org/10.1093/bjs/znag079 Marked disparities in disease presentation, access to treatment, and survival were observed between regions. Tailored regional guidelines are urgently needed to address these inequities and improve outcomes. Work by Sanju Sobnach , Haytham Bayadsi , Urda Kotze , Hanna Nyström , C Wendy Spearman , Mark Sonderup , Inae Kim , Keith Venter , Marc Bernon , Muhammad Emmamally , Luiz F Zerbini , Oskar Hemmingsson , Eduard Jonas #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 #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma #HPBSurgery #GallbladderCancer #Oncology #LiverSurgery

No significant difference in 5-year survival was detected between low and high inferior mesenteric artery ligation in rectosigmoid cancer surgery ➡️doi.org/10.1093/bjsopen/zrag… The optimal level of ligation remains debated: high ligation facilitates apical (station no. 253) lymphadenectomy, whereas low ligation preserves the left colic artery and anastomotic perfusion. This systematic review and reconstructed individual patient data meta-analysis pooled 1152 patients from five trials (34% low ligation), using restricted mean survival time difference (RMSTD) estimation. At 60 months, neither overall nor disease-free survival differed significantly between low and high ligation, with an overall survival RMSTD of 1.40 months (95% c.i. −0.18 to 2.98). Pooled 5-year overall and disease-free survival estimates were 87.3% versus 84.1% and 82% versus 79.2%, respectively, with moderate GRADE certainty for both endpoints. Anastomotic leak, overall complications, lymph node yield, and operating time were comparable. By quantifying survival differences in absolute time, these estimates may inform the choice of ligation level in rectosigmoid cancer surgery. 👏👏👏Alberto Aiolfi, Francesco Cammarata, Emanuele Rausa, Gianluca Bonitta, Antonio Biondi, Luigi Bonavina, Davide Bona #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #CRCSurg #SurgicalOncology #MetaAnalysis #EvidenceBasedSurgery

📢 One place for BJS, BJS Open and BJS Academy content We’re bringing our YouTube and Instagram activity together to make it easier to find and follow content from across the BJS Foundation. Our video library is now available through the central BJS YouTube channel, and future Instagram content from BJS, BJS Open and BJS Academy will be shared through one profile. The aim is simple: easier discovery, stronger engagement, and one home for our community. ➡️ buff.ly/ZFzJDbx @bjsurgery @bjsopen #BJS #BJSOpen #BJSAcademy #SurgicalEducation #SurgicalResearch

Surgical site infection occurred after 10.9% of major lower limb amputations in an international prospective cohort of 1314 procedures ➡️doi.org/10.1093/bjsopen/zrag… Surgical site infection (SSI) after major lower limb amputation (MLLA) remains poorly characterised, despite its influence on wound healing, mobility and rehabilitation. SIMBA was an international prospective observational cohort study of 1314 amputations across 46 centres in the United Kingdom, Europe, Australasia and Asia, with 30-day follow-up. SSI occurred in 10.9% (135 of 1238) of amputations and wound breakdown in 16.8% (204 of 1217); centre-level SSI incidence ranged from 0% to 40%. Estimated glomerular filtration rate below 30 ml/min/1.73 m², cardiac disease, dirty or infected wound classification and transtibial amputation were independently associated with SSI. SSI was associated with increased morbidity, further intervention and delayed medical fitness for discharge (median 15 versus 8 days), without a significant difference in 30-day mortality. 👏👏👏The SIMBA Collaborative Group — Study Management Group: Ismay Fabre, Brenig Gwilym, Louise Hitchman, Nina Al-Saadi, Lakna Harindi Alawattegama, Terry Hughes, Michaela Petit, Katie Worralo, Bryar Kadir, Judith Long, Laura Magill, Andrew Garnham, Ian Chetter, Thomas Pinkney, Matt Popplewell, Michael Wall, @davebosanquet #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #VascularSurgery #LimbSalvage #SurgicalSiteInfection #Amputation #PAD

In cT1–T2, cN0/iN0, HR-positive/HER2-negative breast cancer, mastectomy was not associated with higher nodal involvement than breast-conserving surgery ➡️doi.org/10.1093/bjsopen/zrag… Omission of sentinel lymph node biopsy has been shown to be oncologically non-inferior in patients undergoing breast-conserving surgery, but patients treated by mastectomy were excluded from the pivotal trials. This single-centre retrospective cohort study analysed 454 patients with cT1–T2, cN0/iN0, hormone receptor-positive/HER2-negative breast cancer who underwent upfront surgery including sentinel lymph node biopsy between 2014 and 2024, of whom 145 (31.9%) underwent mastectomy. Node-positive disease was identified in 18.6% after mastectomy and 14.9% after breast-conserving surgery (P = 0.149). Potentially missed indications for adjuvant abemaciclib, ribociclib and regional nodal irradiation did not differ by type of breast surgery. Lymphovascular invasion, but not surgical approach, was independently associated with nodal involvement (OR 6.8, 95% c.i. 3.7 to 12.8). The findings support further evaluation of sentinel lymph node biopsy omission in selected patients undergoing mastectomy. 👏👏👏Martin Heidinger, Giacomo Montagna, Florian S Halbeisen, Anna-Lena Eberhardt, Nadia Maggi, Marie Louise Frevert, Karol Dollt, Rama Kiblawi, Julie M Loesch, Jelena Winkler, Fabienne D Schwab, Christian Kurzeder, Tibor A Zwimpfer, Walter P Weber #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #BreastSurgery #BreastCancer #SLNB #AxillarySurgery #SurgicalOncology

Treatment recommendation issued at a multidisciplinary team meeting was associated with longer overall survival in Swedish gastric cancer patients ➡️doi.org/10.1093/bjsopen/zrag… Multidisciplinary team (MDT) discussion has been mandated for all Swedish patients diagnosed with gastric cancer since 2015, yet its association with survival has remained largely unexamined. This nationwide register-based cohort study analysed 7813 patients diagnosed with gastric adenocarcinoma between 2006 and 2021, of whom 5279 (68%) received a treatment recommendation at an MDT meeting. Advanced age (80–89 years: OR 0.30, 95% c.i. 0.21 to 0.43) and reduced performance status (ECOG 1: OR 0.68, 95% c.i. 0.56 to 0.81) were associated with lower odds of MDT discussion. MDT treatment recommendation was associated with lower all-cause mortality (HR 0.89, 95% c.i. 0.83 to 0.95), with a median overall survival of 12.0 versus 5.9 months. The association persisted in the subgroups least likely to be discussed, indicating that age, performance status, and clinical stage alone should not preclude MDT referral. 👏👏👏 Jonathan Engborg, Jakob Hedberg, Mats Lindblad, Gustav Linder #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #GastricCancer #UpperGISurgery #SurgicalOncology #MDT

Cumulative energy-device exposure near the recurrent laryngeal nerve was associated with increased injury risk after thyroidectomy ➡️ doi.org/10.1093/bjsopen/zrag… Energy-based instruments are standard in thyroid surgery, but existing safety parameters describe single activations rather than cumulative perineural exposure. This retrospective multicentre cohort study of 7145 thyroidectomies (four centres, 2018–2024) applied target trial emulation, generalized propensity score adjustment and causal machine learning to a thermal accumulation index (TAI) quantifying activation-level energy delivered within 2 mm of the nerve. Higher TAI was associated with postoperative recurrent laryngeal nerve injury (odds ratio 3.01, 95% c.i. 2.35 to 3.87), with an approximately linear dose–response relationship across the observed exposure range; the observed injury rate in the independent test cohort was 2.3%, against a model-projected 0.8% under a low-TAI strategy. The authors position TAI as a candidate exposure metric and the derived individualized thresholds as hypothesis-generating pending prospective validation. 👏👏👏 Zhihong Li, Yiliminuer Ahemai, Zimei Li, Beibei Li, Tianruixue Zhang, Wenwen Zheng, Shaohua Wang, Yan Wang, Yingbin Cai #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #EndocrineSurgery #ThyroidSurgery #PatientSafety #CausalInference #SurgicalDataScience

Pancreatoduodenectomy achieved the highest complete resection and lowest recurrence rates for ampullary tumours, at the cost of greater morbidity ➡️doi.org/10.1093/bjsopen/zrag… This meta-analysis of 80 studies (7904 patients) compared endoscopic resection (ER), transduodenal ampullectomy (TDA) and pancreatoduodenectomy (PD). Pooled recurrence was 12% after ER and after TDA versus 6% after PD in benign and early-stage disease. For malignant tumours, TDA achieved complete resection in 66% versus 97% for PD; accurate preoperative discrimination remains critical. 👏👏👏Anouk J de Wilde, Jan Faes, Karlijn E P E Hermans, Marc G Besselink, Jeska A Fritzsche, Matthias van Haele, Jan-Werner Poley, Rogier P Voermans, Judith De Vos-Geelen, Steven W M Olde Damink, Stefan A W Bouwense #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #MetaAnalysis #Endoscopy #EvidenceBasedSurgery

Patient-led, home-based follow-up for colorectal cancer: DISTANCE multicentre stepped-wedge cluster randomised trial ➡️ doi.org/10.1093/bjs/znag081 The DISTANCE trial suggests that PHFU is a feasible and effective alternative to standard hospital-based follow-up for CRC survivors Work by M H Elise van Driel , Hidde Swartjes , Jobbe M G Lemmens , Seyed M Qaderi , Steven Teerenstra , Jose A E Custers , Marloes A G Elferink , Bob J van Wely , Johanne G Bloemen , Wilhelmina M U van Grevenstein , Peter van Duijvendijk , Emiel G G Verdaasdonk , Marnix A J de Roos , Veerle M H Coupé , Geraldine R Vink , Cornelis Verhoef , Dirk J Grünhagen , Johannes H W de Wilt #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

🏥 Cost-effectiveness of the gluteal turnover flap for perineal wound closure after abdominoperineal resection: randomized clinical trial. Some 165 patients were included, and the gluteal turnover flap closure yielded a mean cost reduction of €8318 (95% confidence interval €928 to €15709), with lower outpatient, specialized wound, and home care costs at 12 months. No significant difference in quality of life was observed. 💬: Comparison with other reconstructive techniques (e.g. muscle or omental flaps) is needed to define the relative cost-effectiveness of the gluteal turnover flap. - Jeongyoon (Jenny) Moon, MD ➡️ bjsacademy.com/bjs-academy/r… @bjsopen

📑 Management of perioperative anaemia – five top tips 💬: Preoperative appropriate supplement, prior pausing of antiplatelets and anticoagulants, intraoperative tranexamic acid as standard of care, restrictive blood transfusion, postoperative IV iron when appropriate. - @GormsenJohanne ➡️ bjsacademy.com/bjs-academy/y… @bjsurgery

A contemporary classification of presacral tumours organizes 76 entities by developmental origin, tissue lineage, and biological behaviour. ➡️doi.org/10.1093/bjsopen/zrag… Presacral tumours are rare and pathologically heterogeneous, and the classification systems in common use — derived from work published in 1949, 1954, and 1975 — predate much of the currently recognized disease spectrum. This study combined a prospectively registered systematic review of surgically managed presacral tumours published between 1975 and 2025 with a retrospective multisite institutional pathology review spanning 1986 to 2025. Of 5997 records identified, 203 studies met inclusion criteria and contributed 181 pathological terms; review of 3606 pathology reports identified a further 19 terms, giving 200 in total. Following harmonization to current WHO terminology and exclusion of non-neoplastic processes, 76 entities were arranged by developmental versus acquired origin, tissue lineage (neurogenic, osseous/haematopoietic, soft tissue, miscellaneous), and biological behaviour. The resulting framework is intended to support diagnostic clarity, multidisciplinary communication, and selection of management pathways. 👏👏👏William R G Perry, Scott R Kelley, Dovile Cerkauskaite, Maurish Fatima, Justin T Brady, Amit Merchea, John C Cheville, Rondell P Graham, Eric J Dozois #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #PelvicSurgery #SurgicalOncology #Sarcoma #SystematicReview

🏥 Anastomotic leak after colorectal surgery: current landscape and future directions 🗨️ Multifactorial complication, risk reduction by ICU fluorescence angiography, tension-free anastomosis, modulation of microbiota and defunctioning stoma. - @GormsenJohanne ➡️ bjsacademy.com/bjs-academy/y…

Length of hospital stay after pancreatic surgery varied from 11 to 28 days across countries in 186 randomized trials ➡️doi.org/10.1093/bjsopen/zrag… Length of hospital stay (LOS) is routinely reported as an outcome measure in pancreatic surgery, yet may reflect healthcare systems, reimbursement models, and discharge practice rather than surgical outcome alone. This systematic review and meta-analysis pooled 186 randomized clinical trials published between 1994 and 2025, comprising 28 381 patients. Mean LOS was 17 days overall and differed significantly by country (P < 0.001) and by type of resection (P = 0.003), ranging from 11 days in the USA to 28 days in Japan; pancreatoduodenectomy was associated with a mean of 18 days versus 12 days for left-sided pancreatectomy. Country remained significantly associated with LOS after adjustment for readmission rate, publication year, and type of resection. In studies comparing minimally invasive with open surgery, the mean difference in LOS was 2 days, with variation between countries. Contextual factors therefore warrant consideration when LOS is used for comparison or benchmarking. 👏👏👏Laetitia Z Hampe, Klaudia Narbekovas, Chenchen Li, Amila Cizmic, Anas A Preukschas, Anna Nießen, Jan Bardenhagen, Faik G Uzunoglu, Ulla Klaiber, Oliver Strobel, Pascal Probst, Thilo Hackert, Felix Nickel, Carl-Stephan Leonhardt #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #SystematicReview #MetaAnalysis #EvidenceBasedSurgery