The British journal of surgery
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Tumour deposits are a prognostic factor for overall survival and distant metastasis in lymph node-negative colorectal cancer. However, the current TNM staging system does not account for the presence of tumour deposits in lymph node-positive colorectal cancer, or for the presence of multiple deposits. This study aimed to investigate the prognostic effect of tumour deposit count in patients with colorectal cancer. ⋯ Tumour deposit count is a negative prognostic predictor of both overall survival and distant metastasis in colorectal cancer, independent of positive lymph nodes or neoadjuvant treatment. These findings suggest that tumour deposit count should be integrated into the TNM staging regardless of lymph nodes status to improve prognostic accuracy.
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Observational Study
WHO Disability Assessment Schedule 2.0: responsiveness in detecting long-term functional disability after surgery.
The WHO Disability Assessment Schedule (WHODAS) 2.0 is widely used for detecting postoperative functional disability. Its responsiveness for detecting disability has been evaluated at 1 year after surgery, with no long-term evaluation. The aim of this study was to examine the responsiveness of the WHO Disability Assessment Schedule in detecting functional disability at 5 years after surgery. ⋯ The WHO Disability Assessment Schedule 2.0 has a high responsiveness at 5 years after surgery. It can be used to detect functional disability at 5 years after surgery.
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Large, randomized trials are the bedrock of evidence-based medicine, but the resources required to complete such trials greatly limit the number of important clinical questions that can be addressed within a reasonable period of time. Adaptive platform trials can identify effective, ineffective, or harmful treatments faster. These trials have been shown to deliver rapid evidence through the COVID-19 pandemic and are now being adopted across surgery and anaesthesia, with many opportunities for surgeons, anaesthetists, and other perioperative physicians to conduct and collaborate in platform trials.
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Randomized Controlled Trial Comparative Study
Continuous preperitoneal versus thoracic epidural analgesia in open pancreatoduodenectomy: randomized clinical trial.
Thoracic epidural analgesia (TEA), once the standard for pain management in major abdominal operations, is associated with postoperative complications, making preperitoneal continuous wound infiltration (CWI) a promising alternative. This study aimed to compare the effectiveness of CWI and TEA in managing postoperative pain after open pancreatoduodenectomy. ⋯ CWI was non-inferior to TEA during the early postoperative period, and has emerged as a favourable alternative to TEA, offering better pain relief and enhanced recovery on POD 3. Registration number: NCT04375826 (http://www.clinicaltrials.gov).