BJS Open

Adult choledochal cyst resection in Scandinavia: uncommon malignancy and considerable morbidity in a multicentre surgical cohort
➡️doi.org/10.1093/bjsope…

Choledochal cysts are increasingly identified in adults, and prophylactic resection is usually recommended because of the risk of malignancy, although most data derive from Asian cohorts. This multicentre cohort study examines 62 adults who underwent resection at seven Scandinavian HPB centres between 2010 and 2025; 85% of operations were prophylactic. Major complications (Clavien–Dindo grade III or higher) occurred in 32% of patients, and invasive malignancy was identified in four patients (6%). Resection was associated with considerable short- and long-term morbidity, while invasive malignancy was uncommon in this surgically treated cohort.

👏👏👏Sondre Busund, Jennie Engstrand, Helena Taflin, Bobby Tingstedt, Linda Lundgren, Jozef Urdzik, Ioannis Gkekas, Ernesto Sparrelid, Sheraz Yaqub, Christian Sturesson
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #some4hpb #SurgicalOncology

Recurrence and mortality after non-operative management of acute gallstone disease: nationwide registry study
➡️doi.org/10.1093/bjsope…

Non-operative management of acute cholecystitis, cholangitis and biliary pancreatitis carries a risk of recurrence, and definitive surgery is often deferred in patients with comorbidity. This nationwide registry cohort study identifies 82 101 patients treated non-operatively for gallstone complications between 2006 and 2019, and applies competing risk models accounting for death from other causes. Cumulative recurrence at three years was 19.8% for cholecystitis, 23.0% for cholangitis and 22.5% for pancreatitis. The authors suggest that early cholecystectomy merits consideration in patients with an acceptable operative risk.

👏👏👏Maria Söderström, Olov Norlén, Fredrik Linder, Erik Osterman
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #GeneralSurgery #EmergencySurgery #AcuteCare #HPBSurgery

Adjuvant mFOLFOXIRI after curative-intent resection of oligometastatic colorectal cancer: phase II FANTASTIC trial
➡️doi.org/10.1093/bjsope…

Patients with oligometastatic colorectal cancer remain at high risk of recurrence after curative-intent resection, and the role of adjuvant chemotherapy is uncertain. This multicentre, non-randomized phase II trial enrolled 73 patients (39 receiving adjuvant mFOLFOXIRI, 34 receiving standard of care) and measured circulating tumour DNA (ctDNA) after surgery. The primary endpoint, completion of eight mFOLFOXIRI cycles, was achieved in 74% of patients. ctDNA positivity was associated with inferior recurrence-free survival in both groups. Adjuvant mFOLFOXIRI appears feasible, with possible benefit in patients who are ctDNA-positive after surgery.

👏👏👏Kozo Kataoka, Takeshi Yamada, Kentaro Yamazaki, Shintaro Kanaka, Takeshi Suto, Manabu Shiozawa, Yasumasa Takii, Masayoshi Yasui, Toshifumi Yamaguchi, Nobuhisa Matsuhashi, Naoto Takase, Kazuma Ito, Erik Spickard, Arkarachai Fungtammasan, Rama S Madhurapantula, Adham Jurdi, Eiji Oki, Hideaki Bando, Yoshiaki Nakamura, Takayuki Yoshino, Masataka Ikeda, Keita Mori, Yukihide Kanemitsu
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #colorectalcancer #SurgicalOncology #Oncology

Colonoscopy surveillance after colorectal cancer surgery: meta-analysis
➡️doi.org/10.1093/bjsope…

Colonoscopy surveillance is recommended after colorectal cancer surgery, although the supporting evidence has substantial quality limitations. This systematic review and meta-analysis includes five randomized clinical trials with 2337 patients; four enrolled patients between 1983 and 1994, and all used additional surveillance modalities. Follow-up protocols with colonoscopy were associated with higher detection of asymptomatic recurrence (RR 2.38) and more curative-intent reoperations (RR 1.66), without a corresponding difference in survival (HR 0.92, 95% c.i. 0.77 to 1.11). Contemporary randomized trials are required to define the independent contribution of colonoscopy.

👏👏👏Joni Panula, Kalle E Hokkanen, @Adductor
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #ColorectalSurgery #colorectalcancer #SystematicReview #MetaAnalysis #EvidenceBasedSurgery

Staging laparoscopy for radiographically non-metastatic pancreatic ductal adenocarcinoma: cytology-driven upstaging and the SENDAI-SL risk-enrichment score
➡️doi.org/10.1093/bjsope…

Cross-sectional imaging may miss occult metastases and cannot detect positive peritoneal lavage cytology in pancreatic ductal adenocarcinoma. This retrospective single-centre study analyses 504 consecutive patients with radiographically non-metastatic disease who underwent staging laparoscopy between 2013 and 2025. Staging laparoscopy was positive in 141 patients (28.0%), most often through cytology alone (63.8% of positive procedures). Tumour location, tumour size, CA19-9 level and unresectable locally advanced status were associated with positivity and informed the SENDAI-SL score (AUC 0.732). The score may assist prioritisation where resources are limited, pending external validation.

👏👏👏Daisuke Douchi, Shingo Yoshimachi, Naoki Rikiyama, Mika Ando, Yuichiro Umino, Hideaki Sato, Mitsuhiro Shimura, Koetsu Inoue, Masahiro Iseki, Shuichi Aoki, Takayuki Miura, Shimpei Maeda, Masaharu Ishida, Masamichi Mizuma, Atsushi Masamune, Michiaki Unno
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #PancreaticSurgery #PancreaticCancer #Laparoscopy