The British journal of surgery
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Multicenter Study Comparative Study Observational Study
Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres.
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. ⋯ 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.
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Multicenter Study Comparative Study Observational Study
A national propensity score-matched analysis of emergency laparoscopic versus open abdominal surgery.
Laparoscopy has been widely adopted in elective abdominal surgery but is still sparsely used in emergency settings. The study investigated the effect of laparoscopic emergency surgery using a population database. ⋯ In appropriately selected patients, laparoscopy is associated with superior outcomes compared with open emergency surgery.
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Multicenter Study
Risk prediction model for early outcomes of revascularization for chronic limb-threatening ischaemia.
Quantifying the risks and benefits of revascularization for chronic limb-threatening ischaemia (CLTI) is important. The aim of this study was to create a risk prediction model for treatment outcomes 30 days after revascularization in patients with CLTI. ⋯ This risk prediction model can help in deciding on the treatment strategy in patients with CLTI and serve as an index for evaluating the quality of each medical facility.
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Multicenter Study
Factors associated with delays in revascularization in patients with chronic limb-threatening ischaemia: population-based cohort study.
Prompt revascularization in patients with chronic limb-threatening ischaemia (CLTI) is important, and recent guidance has suggested that patients should undergo revascularization within 5 days of an emergency admission to hospital. The aim of this cohort study was to identify factors associated with the ability of UK vascular services to meet this standard of care. ⋯ Several factors were associated with delays in time to revascularization for patients with CLTI in the UK, most notably the weekday of admission, which reflects how services are organized. The results support arguments for vascular units providing revascularization to have the resources for a 7-day service.
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Multicenter Study
Watchful waiting for small non-functional pancreatic neuroendocrine tumours: nationwide prospective cohort study (PANDORA).
This prospective nationwide cohort study examined the feasibility of a watchful-waiting protocol for non-functional pancreatic neuroendocrine tumours (NF-pNET) of 2 cm or smaller. In total, 8 of 76 patients (11 per cent) with a NF-pNET no larger than 2 cm showed significant tumour progression (more than 0.5 cm/year) during 17 months of follow-up, of whom two opted for resection. ⋯ Quality of life was poorer than in the reference population. Watchful waiting seems a safe alternative to upfront surgery in patients with a NF-pNET no larger than 2 cm, although longer follow-up is necessary.