The British journal of surgery
-
High morbidity and mortality rates after pancreaticoduodenectomy (PD) have led to concentration of this surgery in high-volume centres, with improved outcomes. The extent to which better outcomes might be apparent in a healthcare system where the mortality rate is already low is unclear. ⋯ A significant relationship exists between increasing hospital volume, lower in-hospital mortality, shorter length of stay and lower costs for patients undergoing PD in Japan. Centralization of PD in this healthcare system is therefore justified.
-
A population-based screening programme for abdominal aortic aneurysm (AAA) started in 2010 in Stockholm County, Sweden. This present study used individual data from Sweden's extensive healthcare registries to identify the reasons for non-participation in the AAA screening programme. ⋯ Efforts to improve participation in AAA screening should target the groups with low income, a low level of education and immigrants. The higher morbidity in the non-participant group, together with a higher rate of smoking, make it probable that this group also has a high risk of AAA.
-
The optimal surgical approach to tumours of the oesophagus and oesophagogastric junction remains controversial. The principal randomized trial comparing transhiatal (THO) and transthoracic (TTO) oesophagectomy showed no survival difference, but suggested that some subgroups of patients may benefit from the more extended lymphadenectomy typically conducted with TTO. ⋯ There was no difference in survival or tumour recurrence for TTO and THO.
-
Liver retraction is critical in single-incision laparoscopic upper abdominal surgery. Several techniques have been reported. Some need an additional port, whereas others are complicated and time-consuming. ⋯ Creating adhesion between the left lateral lobe of the liver and the diaphragm using NBCA glue is a simple, safe and effective way of achieving liver retraction in single-incision laparoscopic upper abdominal surgery.
-
The subdivision of T3 in rectal carcinoma according to the depth of invasion into perirectal fat has been recommended in the TNM Supplement since 1993. This study assessed the prognostic impact of this pathological staging in tumours removed after neoadjuvant chemoradiotherapy (ypT3). ⋯ In ypT3 rectal carcinomas, the proposed subclassification is superior to ypN in predicting prognosis.