To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. In total, 188 (39.0
Fusion surgery, where laparoscopic techniques are purposefully integrated into robotic surgery, is a novel approach that can be used in colorectal surgery. However, a standard definition and practical guidance are lacking. Therefore, this study aimed to generate consensus to standardise the definition of fusion surgery and consequently raise awareness of fusion surgical approaches and their appropriate use cases. We conducted a two-round modified Delphi study with 17 colorectal surgeons from Asia–Pacific (5 Steering Committee [SC]; 12 Expert Panellists [EP]). Statements were drafted by the SC based on clinical experience, published literature and comments from the EP. The EP rated these statements anonymously on a 5-point Likert scale. A virtual expert meeting was held between voting rounds to discuss the statements. Consensus was predefined as ≥ 75
BACKGROUND:Recovery following traumatic brain injury (TBI) is highly heterogeneous. Characterising longitudinal functional trajectories may enable more individualised care and inform the trial design. This study aimed to identify distinct patterns of functional recovery in the first 12 months post-injury using the Glasgow Outcome Scale - Extended (GOSE). METHODS:Patients with available GOSE data from Transforming Research and Clinical Knowledge in Traumatic Brain Injury, a prospective, multicentre study, were included. A two-stage multiple imputation procedure addressed missingness, and trajectories were modelled using polytomous variable latent class analysis (poLCA) in both complete-case and imputed datasets. RESULTS:Among the 2,100 participants with TBI, poLCA identified seven distinct recovery trajectories based on GOSE scores. These included (1) death (6.2%), (2) persistent GOSE 2-5 (5.7%), (3) improvement from GOSE 3-5 to GOSE 5 by 3 months with no further gains (9.0%), (4) rapid improvement from GOSE 3-5 to GOSE 7-8 sustained through follow-up (7.0%), (5) gradual improvement from GOSE 3-6 to GOSE 5-7 over 6 months (15.3%), (6) rapid early improvement from GOSE 4-7 to GOSE 6-8 by 3 months and then plateauing (21.8%) and (7) progression from GOSE 5-8 to GOSE 7-8 within 3 months, with stable outcomes thereafter (25.1%). Recovery class membership was significantly associated with the initial Glasgow Coma Scale scores, CT severity (Marshall and Rotterdam scores) and presence of psychiatric comorbidities. CONCLUSIONS:Our findings support a shift towards trajectory-based stratification in clinical care and research. Incorporating these patterns into prognostic modelling may improve outcome prediction, personalise rehabilitation and refine eligibility criteria for interventional trials.
INTRODUCTION:Bloodstream infections (BSIs) are an important complication among injured patients, yet existing studies have focused on selected populations or specific settings, limiting the generalisability of the findings. In this study, we conducted a population-based study to examine the incidence, demographic and clinical variation of injury-related BSIs. METHODOLOGY:The study population consisted of all residents of Queensland, Australia, who developed an injury-related BSI identified between 1 January 2000 and 31 December 2019. The linked data used for this study consisted of three statewide databases of all public and private hospital admissions, public pathology data and deaths. ICD-10 AM codes for injuries (S00-T75 and T79) were used to identify hospitalisations for index injuries. Incidence rates were calculated by age, sex, geographic remoteness and socio-economic status using estimated residential population data and aggregated acute injury hospital episodes. RESULTS:Across 20 years, a total of 3205 injury-related BSI episodes occurred among 3188 individuals. The median age of this cohort was 63 years, with males accounting for 65 % of the population. The overall 30-day case-fatality rate was 13 %. During the study period, age-standardised rates increased from 2.47 to 4.62 per 100,000 population, with males experiencing higher rates than females. Patients from remote areas in Queensland had significantly higher rates compared to those from other regions. Additionally, age-specific rates increased with advancing age. Approximately two-thirds of the injury-related BSI episodes were hospital-onset. The most commonly identified pathogens among these patients were Staphylococcus aureus and Escherichia coli. CONCLUSION:This world-first population-based study on injury-related BSIs provides a comprehensive understanding of the incidence and variation by demographic and clinical characteristics. Injury-related BSIs differed across subgroups: males, remote area residents and older people had higher rates than females, urban/regional area residents and younger individuals. These findings provide a foundation for further work to target treatment and interventions to minimise the burden of injury-related BSIs.
BACKGROUND:Stereotactic ablative body radiotherapy (SABR) is a non-invasive therapy for inoperable primary renal cell carcinoma. However, long-term prospective clinical trial data are scarce. We aimed to use pooled data from two clinical trials (FASTRACK and FASTRACK II) to evaluate activity and safety of SABR in the long term. METHODS:In this pooled analysis, we used data from FASTRACK, a single-institutional, phase 1, prospective clinical trial conducted at the Peter MacCallum Cancer Centre (Melbourne, VIC, Australia), and FASTRACK II, an international, non-randomised, phase 2 clinical trial conducted in seven academic hospitals in Australia and one in the Netherlands. The treatment protocol, inclusion and exclusion criteria, and dose constraints were the same in both trials. Patients had primary renal cell carcinoma and were deemed medically inoperable or high-risk for surgery, were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status of 2 or less, tumours of 10 cm or less in maximal dimension, and N0-N1 disease. Tumours 4 cm or smaller in FASTRACK II and smaller than 5 cm in FASTRACK received a single fraction of 26 Gy and larger tumours received 42 Gy in three fractions 48 h apart. Local control (freedom from local progression) was the primary endpoint, assessed using Response Evaluation Criteria in Solid Tumours (version 1.1) criteria. The analyses were conducted only in patients who commenced protocol treatment. Safety was evaluated with the Common Terminology Criteria for Adverse Events in participants who started protocol treatment. A patient representative was involved in the study design and conduct of FASTRACK II. Both trials were registered with ClinicalTrials.gov (FASTRACK: NCT01676428; FASTRACK II: NCT02613819) and are both completed. FINDINGS:108 patients were enrolled between June 28, 2012, and Oct 17, 2014 (FASTRACK), and between July 28, 2016, and Feb 27, 2020 (FASTRACK II). Five patients did not receive treatment (one opted for surgery, three did not meet dose constraints and were withdrawn, and one died before treatment). Median age was 76·9 years (IQR 70·0-81·9). 74 (72%) of 103 patients analysed were male and 29 (28%) were female. Race and ethnicity data were not collected. The median follow-up was 5·0 years (IQR 2·3-6·0). Local control at 1 year was 100%, at 3 years was 98% (89-100), and at 5 years was 98% (89-100), with local progression occurring in only one patient who had both local and distant progression at 28 months. Eight (8%) patients had grade 3 adverse events: abdominal or flank pain (four [4%] patients), nausea or vomiting (two [2%]), colonic obstruction (two [2%]), fatigue (one [1%]), and colitis or diarrhoea (one [1%]). All grade 3 or worse adverse events occurred within 2 years of SABR delivery. No grade 4 adverse events or treatment-related deaths were reported. INTERPRETATION:This pooled analysis from two clinical trials of SABR in patients with larger primary kidney tumours unsuitable for surgery supports evidence of long-term local control and low rate of severe adverse events. These results support further investigation through a randomised trial comparing SABR with surgery in select operable patients. FUNDING:None.
