BACKGROUND:Effective multimodal analgesia is essential after minimally invasive colorectal surgery. This randomized trial evaluated whether adding surgeon-performed surgical rectus sheath block (SRSB) or laparoscopic bilateral dual transversus abdominis plane (BD-TAP) block to intravenous patient-controlled analgesia (IV-PCA) improved postoperative quality of recovery. METHODS:This single-centre, three-arm superiority trial randomized adults undergoing minimally invasive colorectal resection (1 : 1 : 1) by stratified block allocation at a Japanese cancer centre. Patients and outcome assessors were blinded. The primary outcome was the Japanese version of the 15-item Quality of Recovery questionnaire (QoR-15) score 24 h after arrival in the postanaesthesia care unit. Missing postoperative QoR-15 item responses were handled using multiple imputation, and treatment effects were estimated using ANCOVA adjusted for the four randomization stratification factors. Each primary comparison used a Bonferroni-adjusted one-sided significance level of 0.025. Secondary outcomes included the 48-h QoR-15 score, postoperative pain scores, time to first rescue analgesia, and cumulative consumption of analgesics and antiemetics over 48 h. RESULTS:Between July 2024 and December 2025, 320 patients were randomized (control, 110; SRSB, 107; and BD-TAP block, 103); 309 were analysed (105, 103, and 101 respectively). Compared with control, BD-TAP block resulted in a higher 24-h QoR-15 score (adjusted mean difference 10.44 (95% c.i. 3.06 to 17.83) points; one-sided P = 0.003), whereas superiority of SRSB was not demonstrated (adjusted mean difference 5.50 (95% c.i. -1.88 to 12.89) points; one-sided P = 0.072). At 48 h, the adjusted mean difference for BD-TAP block versus control was 8.01 (95% c.i. 0.18 to 15.83) points (two-sided P = 0.045), an exploratory finding unadjusted for multiplicity. The median time to first rescue analgesia was longer with SRSB (27.8 h) and BD-TAP block (25.3 h) than control (3.3 h), but cumulative 48-h fentanyl consumption and length of hospital stay did not differ significantly. No block-related complications were observed. CONCLUSION:BD-TAP block resulted in better 24-h recovery than IV-PCA alone. Superiority of SRSB was not demonstrated. REGISTRATION NUMBER:jRCT1031240153 (Japan Registry of Clinical Trials).
BACKGROUND:Gastric cancer surgery has historically implied significant levels of clinical burden and mortality. Postoperative duodenal stump leakage (DSL) represents a leading cause of postoperative mortality, but international occurrence rates and treatment strategy are lacking. The aim of this multinational retrospective cohort study was to evaluate the occurrence rate and treatment strategy factors for duodenal stump leakage after gastrectomy for cancer. METHODS:This retrospective multinational multicentre cohort study (the STARDUST study) retrospectively analysed a consecutive series of gastric cancer patients who underwent gastrectomy from 2019 to 2022 at 24 high-volume European members of the GASTRODATA registry. The primary outcomes included postoperative incidence and 90-day mortality after DSL. Secondary outcomes were clinical presentation, perioperative determinants, and complication treatment. RESULTS:A total of 2558 consecutive gastric cancer patients were identified from the registry and 2422 were eligible for the study. DSL occurred in 2.6% (64 of 2422) of the patients with a subsequent 90-day mortality rate of 17.2% (11 of 64). Conservative treatment was used for nine patients, followed by successful recovery without readmission. Interventional radiology was used for 16 patients (treatment success rate of 75%), while 39 patients required reoperation for acute presentation or failure of conservative options (treatment success rate of 74.4%). Multivariate analysis identified statistically significant independent prognostic factors for DSL, including preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion. CONCLUSION:Postoperative DSL was uncommon (2.6%), but it was associated with a 90-day mortality rate of 17.2%, which varied according to the severity of the clinical presentation and the invasiveness of the treatment. Preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion were prognostic factors associated with complication occurrence. The results need to be validated and prospectively endorsed within a standardized protocol guiding the intraoperative management of the duodenal stump and the choice of complication treatment.
BACKGROUND:Surgical site outcome (SSO) reporting lacks details of management, focuses on infection, and overlooks dehiscence, seroma and haematoma. An international, consensus-driven classification system applicable to a diverse range of surgical incisions and outcomes was developed to address this gap and standardise the reporting of SSOs. METHOD:Concept statements based on a targeted literature review were rated by pan-specialty global experts during a four-round modified Delphi study to create a comprehensive classification of SSOs. Reliability and language validation focused on inter-rater agreement and intra-rater reproducibility by experts applying the classification to case vignettes, created using generative artificial intelligence sampling. Cross-domain agreement was evaluated using a patient-level, double entry, interclass correlation coefficient (DE-ICC). RESULTS:Consensus was achieved on definitions of dehiscence, inflammation/infection, seroma and haematoma ('DISH') within a new classification, comprising five objectifiable grades of clinical intervention (0-4) and four grades of clinical presentation (a-d) for each domain. The DISH 'score' presents all domains collectively, e.g. D1a I2b S0 H0; a snapshot of management and presentation of an incision. Mean patient-level inter-rater DE-ICC was 0.93 (95% confidence interval [CI] 0.91-0.96; median 1.00; very high concordance). Intra-rater DE-ICC was similarly high (mean 0.95; 95% CI 0.93-0.96; median 1.00). CONCLUSION:The proposed cross-specialty, global DISH Classification facilitates more comprehensive surveillance and audit of SSOs in clinical practice and research, by standardising reporting of all relevant grades of clinical presentation and management of SSOs. Very high concordance when applied to case vignettes gives credibility to clinical validation and adoption.
INTRODUCTION:Molecular and cellular imaging biomarkers of abdominal aortic aneurysms (AAA) show promise as potential predictors of clinical events. This study assessed long-term clinical outcomes using ultrasmall superparamagnetic particles of iron oxide (USPIO) enhanced magnetic resonance imaging (MRI; ISRCTN76413758) and fluorine-18 sodium fluoride ([18F]NaF) positron emission tomography computed tomography (PET/CT; NCT02229006). METHODS:A prospective multi-centre co-enrolled observational cohort studies of patients with asymptomatic AAA. Evaluation of aortic wall inflammation using USPIO-enhanced MRI in 338 patients was followed by [18F]NaF PET/CT in a sub-group of 72 patients, to evaluate microcalcification. Aneurysms were classified according to aortic wall USPIO enhancement and into tertiles of [18F]NaF uptake. Aneurysm expansion, composite of rupture or repair, and overall survival were compared. RESULTS:In 338 predominantly elderly (74±7.2 years) men (85%) with mean aneurysm diameter 49.5±7.3 mm, aneurysm expansion was increased in patients with USPIO enhancement (median [inter-quartile interval], 3.3 [2.0-4.6] versus 2.5 [1.4-3.6] mm/y; p=.002) or high [18F]NaF uptake (4.0 [2.6-5.4] versus 1.9 [0.9-3.0] mm/y; p<.001), even when adjusted for hypertension, smoking and baseline AAA diameter (p=.04 and p=.003). After a median follow up of 102 [58-119] months, 63% patients met the composite endpoint of rupture or repair with high [18F]NaF uptake associated with more than two-fold higher risk (72% versus 36%; log rank p=.002). There was no association between USPIO enhancement and future rupture or repair. CONCLUSIONS:Aortic wall USPIO enhancement and [18F]NaF uptake are independently associated with AAA expansion. These non-invasive imaging biomarkers provide an opportunity to identify those are at greatest risk of AAA progression and may help inform further research to determine optimal surveillance intervals.
Abstract Introduction miRNA are small, noncoding RNA sequences for control of gene regulation in tissues, including skeletal muscles. Thus, miRNAs may be related to exercise capacity, physical performance and muscle atrophy, in progressive cancer cachexia. Therefore, we applied untargeted, large panel analyses on miRNAs in blood from patients with progressive PDAC tumours and weight loss. Methods 2083 miRNAs were analyzed in blood plasma by HTG edge-seq miRNA whole transcriptome assay. Samples were from PDAC patients at consideration for surgery (n = 32); and at disease progression (n = 22). Controls were blood donors (n = 10). For group comparisons, global data normalization was performed to construct relative miRNA distributions, followed by Bonferroni-Dunn-corrected t-tests on log2 Foldchange values >1.5. Inferences between miRNA, systemic inflammation, physical performance, standard laboratory tests and tumor markers were evaluated by regression analyses. Results miR23a-5p, miR-766-5p and miR-6741-5p were significantly increased in blood samples from PDAC patients versus controls, at time for surgical considerations (P = 2.46 E-5); with strong inter-correlations among the significant miRNAs (R = 0.62–0.82, n = 64). Calculations on all PDAC patients showed that significantly increased miRNAs correlated negatively to CRP, physical performance (oxygen consumption and walking speed on treadmill; P < 0.05–0.01); and positively to s-albumin (R∼0.3, P < 0.06). miR-23a-5p and miR766-5p showed positive correlations to s-IGF-1 (P < 0.02). Karnofsky performance index was positively correlated to the significantly increased miRNAs at surgical considerations (R = 0.42–0.56; P < 0.05). Discussion Previous studies have linked miR-23a to exercise, and miR-766 to regulatory genes in skeletal muscles. Significant correlations among miR-23a-5p, miR-766-5p and miR-6741-5p imply impact(s) on physical functioning in PDAC patients.
Abstract Introduction Surgical procedures are common and are predicted to continue to increase in number. Risk of complications is between 6% to 44% and affected by several different factors. Postoperative mobilization can reduce the risk of many complications and alleviate several postoperative symptoms. The effects of mobilization after surgery have long been recognized in healthcare, despite this, it still lacks a clear definition. The aim of this study was to investigate the experience of postoperative mobilization in hospitals, from a patient and health care worker’s perspective. Methods A systematic literature review that included qualitative studies along with one mixed method studie, of which only the qualitative part was included. The literature search was conducted in the databases PubMed, Cinahl and Scopus. A total of 12 articles were identified. An inductive manifest analysis was conducted according to Bettany-Saltikov & McSherry's procedure. Results Three themes; The emotional experience, The importance of and impact of mobilization during the care process, The impact of the environment, based on eight subcategories. Discussion The experience of postoperative mobilization varies and is influenced by both individual factors and the surrounding context. The mobilization process is dynamic, where symptoms both arise and are alleviated. The patient's attitude and emotional commitment affect the implementation and a collaboration between the care team, the patient and relatives is crucial. Postoperative mobilization occurs after all forms of surgery regardless of the surgical size or preoperative abilities.
Abstract Introduction Isolated limb perfusion (ILP) is an established treatment for melanoma in-transit metastases (ITM), but the optimal balance between perfusion duration and temperature to maximise response while minimising toxicity remains unclear. Methods A single-centre retrospective analysis of 411 patients undergoing first-time ILP for melanoma ITM, with or without nodal disease, between 1976 and 2025. The primary outcome was complete response (CR). Perfusion time and ingoing perfusate temperature were analysed as continuous variables using multivariable logistic regression with a time–temperature interaction term. Tumour burden, prior systemic therapy, melphalan dose, and treatment era were included as covariates. Toxicity (Wieberdink grade III–IV versus I–II) was assessed secondarily. Results The CR rate was 56%, with a modest decline across eras coinciding with shorter perfusion durations. Longer perfusion time increased odds of CR (OR 1.14 per 10 min, 95% c.i. 1.04–1.27; P = 0.009). A significant interaction with temperature (OR 0.981; P = 0.019) demonstrated attenuation of the time effect at higher temperatures. Increasing tumour burden was associated with reduced response (OR 0.985 per lesion; P = 0.001), with stepwise reductions for 10–30 and >30 metastases. Among 387 patients, 40% developed grade III–IV toxicity. Higher temperature increased toxicity (OR 1.91; P = 0.001), whereas perfusion time was not associated. External iliac access was associated with lower toxicity (OR 0.43; P = 0.007). Findings were unchanged after adjustment for tumour burden, prior systemic therapy, melphalan dose, and treatment era. Discussion Perfusion duration and temperature have distinct roles in ILP, duration influencing efficacy and temperature determining toxicity. Extending perfusion duration at lower temperatures may improve response without increasing clinically relevant toxicity.
Abstract Introduction The main decision in pediatric acute scrotum is to decide if the boy has testicular torsion (TT). TWIST-score is validated and a metaanalysis deemed the Barbosastratification (0–2, 3–4, 5–7) most reliable with no low risk (0–2) patients having TT. We aimed to evaluate the accuracy of this stratification in our setting. Methods A multicenter prospective study between 2019–2022 including boys between 2 weeks-16 years with ≤5 days of symptoms. In a second stage, boys who underwent acute scrotal exploration during 2019–2022 were analyzed. The diagnosis of TT was defined as detorsion of, or ischemic, testis. Results 317 boys were included prospectively and 30 boys retrospectively. Median age was 12 years. Ultrasound was performed in 39% (124/317) of cases and 35% (112/317) were explored. Negative exploration rate was 29% (32/112). The other 80 boys had confirmed TT/ suspected intermittent TT/Bell clapper deformity. There were 22% (69/317) confirmed TT. Among these, 17 (25%) had low-risk (0–2), 17 (25%) intermediate risk, and 35 (51%) a high-risk score. In the retrospective group 53% (16/30) TT were identified of which 1 (6%) had a low-risk score. In the low-risk group, ultrasound was performed in 4/17 and surgical decision was based on the pain characteristics (n = 15) and ultrasound (n = 2). Discussion TWIST-score is useful when utilized as intended: to minimize ultrasounds in low-score, and delay of surgery in high-score, patients. However, low scores should not be interpreted as ‘no risk of TT’ since 1/3 in this cohort would have been missed. Other parameters must be a part in the decision of exploration.
Abstract Introduction While structured reflection is limited in inpatient care, the need to strengthen nursing visibility and quality remains high. Using the Fundamentals of Care framework, a book club provides a resource-efficient method for knowledge development in clinical teams. This study explored the implementation of a book club in an inpatient ward. Methods This development project was conducted on a surgical ward. Approved by the department head, the Fundamentals of Care book club consisted of two parallel groups to enable participation. Nursing staff met for 45 min during shift overlaps six times over three months. Participants discussed pre-read book sections, focusing on clinical application. Results Seven RNs and four assistant nurses participated in groups scheduled by work shifts. Four meetings have been held (completing May 2026). Attendance declined over time, primarily due to clinical priorities, shift changes, and varying preparation levels. Discussion Implementing a Fundamentals of Care book club in inpatient care is feasible but depends on leadership support and staff commitment.
Abstract Introduction Perioperative intravenous (IV) lidocaine can reduce postoperative pain, opioid use, bowel recovery time and the length of stay, but is rarely tested in liver surgery. This study evaluated the postoperative analgesic efficacy and safety of IV lidocaine in patients undergoing minor liver surgery. Methods Patients undergoing minor liver surgery were randomized 1:1 to receive either perioperative IV lidocaine, administered as a 1.5 mg/kg bolus followed by an infusion of 1.5 mg/kg/h until 1 h after surgery, or placebo. Patients received postoperative opioid analgesia via a patient-controlled analgesia device. The primary outcome was postoperative opioid consumption during the first 24 h after surgery. Secondary outcomes included postoperative pain scores, quality of recovery, adverse events, length of stay, and plasma lidocaine concentrations. Results In total, 124 subjects were included. Postoperative opioid consumption during the first 24 h after surgery was 97 (60–135) mg oral morphine equivalents (OME) in the placebo group, and 83 (50–129) mg OME in the lidocaine group, P = 0.429. Patients in the lidocaine group experienced lower early pain scores, but not from postoperative day 1 onward. Quality of recovery score did not differ, and adverse events were similar between groups. In two cases, plasma concentrations of lidocaine were transiently above 5 µg/ml after bolus administration, without clinical toxicity. Plasma concentrations after resection and at end of infusion were safely below. Discussion Perioperative intravenous lidocaine did not reduce postoperative opioid consumption after minor liver surgery but conferred transient early analgesic benefits and was found to be safe.
Abstract Introduction Venous resection is performed during pancreatic surgery to achieve cancer-free margins. This study aimed to explore the prognostic value of pre-operatively available factors for survival in patients undergoing pancreatoduodenectomy with concomitant venous resection. Methods This retrospective study used the Swedish National Pancreatic Cancer Registry to identify patients with resectable or borderline resectable pancreatic adenocarcinoma undergoing pancreatoduodenectomy in 2017–2024. Pre-operatively available patient- and disease-specific factors were compared between patients with and without concomitant venous resection using chi-square and Mann-Whitney U tests. Predictive values for survival were explored with adjusted Cox proportional hazards models. Results Among the 1626 patients included, 410 (25.2%) underwent concomitant venous resection. Patients undergoing venous resection more often had borderline tumours (19.3% versus 3.6%, P < 0.001), received neoadjuvant therapy (17.8% versus 4.9%, P < 0.001), and presented with higher baseline CA19-9 (median: 146.7 versus 85.0, P = 0.016). Postoperative pancreatic fistulae were less common among patients undergoing venous resection (5.0% versus 9.8%, P < 0.001), while post-pancreatectomy hemorrhage, bile leakage, delayed gastric emptying, and postoperative morbidity were similar between the groups. Worse survival associations were found for elevated C-reactive protein (HR 1.62; 95% c.i. 1.18–2.22, P = 0.003), diabetes (HR 1.44; 95% c.i. 1.03–2.02, P = 0.032), and pulmonary disease (chronic obstructive pulmonary disease, dyspnea at conversation and/or at rest) (HR 2.11; 95% c.i. 1.23–3.61, P = 0.006). Unintentional weight loss was associated with improved survival (HR 0.70; 95% c.i. 0.52–0.94, P = 0.019). Discussion Elevated C-reactive protein, diabetes, and pulmonary disease are associated with poor prognosis, while unintentional weight loss is associated with improved prognosis in patients undergoing venous resection.
Abstract Introduction Internal Classification of Disease (ICD) codes are used both to identify patients treated for appendicitis, as well as to determine disease severity. The current study aimed to evaluate the validity and discriminating capacity of ICD-10 codes for appendicitis in the Swedish National Patient Register. Methods A single-center retrospective cohort study including all consecutive patients who received an ICD-code for appendicitis (K352, K353, K358, K369, K379) at Skåne University Hospital Malmö and Lund during 2022–2024. ICD-codes were compared to clinical diagnoses according to intraoperative, histopathological and radiological findings. The validity was determined using positive predictive value (PPV). The ICD-codes ability to discriminate between uncomplicated (phlegmonous appendicitis) and complicated (gangrenous and perforated appendicitis or appendicitis abscess) were evaluated using sensitivity, specificity, PPV and negative predictive value (NPV). Results The cohort consisted of 2061 patients with a median age of 31 (IQR 18–46) years. 53.1% were male. 94.1% had a appendicitis, and out of these 51.4% had complicated appendicitis. The PPV for all cases of appendicitis was 94%. The ICD-code K352 had the best individual PPV of 90%, but for the remaining codes it ranged between 46–62%. The discriminating capacity of ICD-codes was modest: sensitivity 59.2%, specificity 63.7%, PPV 63.3% and NPV 59.6%. Discussion While an absolute majority of all patients who received an appendicitis ICD-code also had a clinical appendicitis diagnosis, the ICD-codes reported from Skåne University Hospital cannot to a satisfactory extent discriminate between uncomplicated and complicated appendicitis. They should therefore be used with caution for this purpose in research and quality improving efforts.
Abstract Introduction Primary mastectomy with immediate breast reconstruction (IBR) is increasingly performed, with described outcomes and complication profiles. In contrast, postoperative outcomes after completion mastectomy with IBR following breast-conserving therapy (BCT) for positive margins remain limited. This study compared early and delayed postoperative complications after mastectomy with IBR in patients with and without prior BCT. Methods A total of 107 patients with clinically node-negative breast cancer were included. Patients were treated at Skåne University Hospital in Malmö between 2014 and 2020 and underwent either primary mastectomy with IBR (n = 63) or initial BCT followed by completion mastectomy with IBR due to positive margins (n = 44). Baseline patient characteristics, reconstruction method, and postoperative outcomes were obtained from medical records. Early postoperative complications (<30 days) included haemorrhage, seroma formation, and surgical site infection. Delayed complications (≤1 year) were evaluated. Results Age, BMI and tumour size were comparable in the two groups. Implant-based reconstruction was more commonly performed than autologous reconstruction in both groups and was more frequent after primary mastectomy than after completion mastectomy (91 versus 74%). Completion mastectomy with IBR after prior BCT was associated with higher rates of postoperative haemorrhage (11 versus 8%) and seroma formation (9 versus 5%). Delayed complication rates were similar between the groups. Discussion Completion mastectomy with IBR after prior BCT demonstrated higher rates of haemorrhage and seroma formation within 30 days postoperatively than primary mastectomy with IBR. These findings warrant further evaluation in larger cohorts.
Abstract Introduction RAMIE has been shown to be non-inferior to hybrid and open Esophagectomy. We have introduced robot assisted upper gastrointestinal surgery in a stepwise manner in our institution during a time period of three years. We report our first results after RAMIE. Methods Two surgeons from the upper GI-surgery team were taught robotic surgery through a structured teaching program including robotic simulator training, lab training and proctored live surgery. Independent robotic surgery was developed from hiatal hernia procedures to abdominal part Esophagectomy, Gastrectomy to thoracoabdominal Esophagectomy. RAMIE has been performed for approximately 14 months in our institution. The anastomosis is stapled, linear side-to-side with the robotic SureForm stapler, routinely proximal to the Azygos vein. ICG is used to assess the Gastric Tube. There was no patient selection for RAMIE. Access to robotic surgery was approximately three days in a month. Results Twentyseven patients have undergone RAMIE, two of which were McKeown procedures, all others Ivor Lewis esophagectomy. Mean operating time was 434 min, median length-of-stay was 9 postoperative days. Surgical complications, Clavien Dindo ≥3, occurred in 5 patients. In total, anastomotic leakage occurred in one patient, treated by EVAC. Chyle-leakage occurred in four cases, two treated with re-operation and two treated with drainage. Discussion Complex robotic surgery can be introduced maintaining good surgical results. Prerequisites are structured training, regular access to the robot and aiming at a high surgical volume for each robotic surgeon.
Abstract Introduction Pancreatic ductal adenocarcinoma is a highly aggressive malignancy. Postoperative surveillance after curative-intent surgery remains a matter of debate, without established guidelines for recommended surveillance strategies. This study aims to compare post-recurrence treatment and survival between patients with recurrence detected at scheduled controls versus due to symptoms. Methods Retrospective single-center study (2009–2023). All patients were part of a surveillance program, including computed tomography (CT) at 6, 12, 18, 24, and 36 months after surgery. Survival and treatment after recurrence were compared between patients with recurrence detected at scheduled follow-up and those detected between controls due to symptoms. Results In total 142 patients were included in the surveillance program. Patient characteristics, including tumor characteristics and neoadjuvant and adjuvant treatment, were similar in both groups. Recurrence detected by scheduled CT was associated with a greater likelihood of receiving post-recurrence treatment (84% versus 68%, P = 0.020). Median overall survival after recurrence for patients detected through scheduled radiological examination was 15 months compared to 9 months for patients detected between controls due to symptoms (15 (7–28) versus 9 (3–17), P = 0.027). For recurrence-free survival, no difference was recorded (15 (12–24) versus 16 months (10–26), P = 0.495). Discussion Patients with recurrence detected by scheduled follow-up CT were more likely to receive treatment for recurrence and also had significantly longer overall survival after recurrence compared to patients with recurrence detected due to symptoms.
Abstract Introduction This study aimed to evaluate the diagnostic performance of plasma sodium in identifying complicated appendicitis among pediatric and adult patients with appendicitis, and to compare its performance with conventional inflammatory markers. Methods A retrospective cohort study of all consecutive patients treated for appendicitis at Skåne University Hospital between 2022 and 2024. Disease severity was based on intraoperative and histopathological findings, or radiology in the case of non-operative management. The diagnostic performance of plasma sodium compared to conventional inflammatory markers (C-reactive protein, leukocytes and neutrophils) were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUROC). Results 1467 adults and 458 children were included. Complicated appendicitis was associated with higher inflammatory markers and lower plasma sodium levels in both children and adults. In children, plasma sodium <135 mmol/l yielded a specificity of 98.1 (95% c.i. 93.2–99.8) percent and a PPV of 94.6 (95% c.i. 81.2–98.6) percent. In the adult cohort, the specificity was 99.3 (95% c.i. 98.4–99.8) percent and PPV of 91.1 (95% c.i. 80.4–96.2) percent. Plasma sodium demonstrated a moderate ability to discriminate complicated from uncomplicated appendicitis in both children (AUROC 0.719, 95% c.i. 0.656–0.783) and adults (AUROC 0.657, 95% c.i. 0.629–0.684). These AUROC:s were comparable to those for CRP, leukocytes and neutrophils. Discussion A plasma sodium <135 is a strong indicator of complicated appendicitis in both adult and pediatric patients. Plasma sodium should not be used as a sole indicator to rule out complicated disease.
Abstract Introduction The effectiveness of current follow-up recommendations after breast cancer remain uncertain. Early detection of local recurrence improves survival, but surveillance strategies are largely uniform despite significant differences in recurrence risk. Interval recurrences detected between scheduled visits are more likely in younger patients and those with non-luminal subtypes. In addition, mammography has lower sensitivity in breast cancer survivors compared to healthy women. Supplemental imaging methods, such as magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM), may improve detection in high-risk groups. This study aims to evaluate whether more sensitive imaging methods enable earlier detection of second breast cancers after breast-conserving surgery (BCS) in patients with high recurrence risk. Methods A multicenter, open-label, R-RCT including patients from the National Quality Register for Breast Cancer. Women aged <50 years, or women of any age with HER2-positive or triple-negative breast cancer who have undergone BCS, will be randomized to standard follow-up with annual mammography for five years or the same regimen with the addition of MRI or CEM at years 2 and 4. The primary endpoint is the number of interval-detected ipsilateral and contralateral second breast cancers within five years. Secondary endpoints include recurrence stage, survival, recall and biopsy rates, false-positive findings, and health-related quality of life. Based on power calculations (4 versus 2%), 2300 patients (1:1) are required to achieve 80% power. Results Recruitment will begin in 2026, with first interim results expected in 2029. Discussion There is an unmet need for individualized breast cancer surveillance guidelines. This study aims to help address this evidence gap.
Abstract Introduction It has been suggested that mrEMVI (extramural venous invasion) and mrTD (tumour deposits) have important predictive roles in recurrence after rectal cancer treatment. The aim of this study was to investigate whether mrEMVI and mrTD on preoperative MRI have predictive value for the risk of distant recurrence. Methods This study builds on the Rectoleak study, a retrospective national multicetre study including patients who underwent rectal resection anastomosis between 2014 and 2018. Pelvic MRI images from patients at three hospitals were centrally reviewed for T- and N-stage, mesorectal fascia (MRF) involvement, mrEMVI and mrTD. Data on distant recurrence were obtained from the Swedish Colorectal Cancer Registry. Logistic regression was used to evaluate the predictive value of the variables. Results In total, 458 patients were included (39% women, mean age 64 years) of whom 219 (48%) received neoadjuvant treatment. Eighty-three patients (18%) developed distant recurrence, during a mean follow-up time of 4.2 years. Thirthy-eight patients (8%) had positive mrTD and 71 (16%) had positive mrEMVI. Among the variables analyzed, the strongest predictive value was observed for mrTD, HR 2.03 (95% c.i. 0.96–4.28). The corresponding value for mrEMVI was HR 1.80 (95% c.i. 0.92–3.50). Discussion The findings suggest that mrTD and mrEMVI on preoperative MRI may have additional predictive value for the risk of distant recurrence after rectal resection, with mrTD appearing to be the stronger predictor.
Abstract Introduction The Detailed Characteristics of a first-time Acute Pancreatitis cohort during 10 years (DeCAP) was established to study both short- and long-term outcomes following acute pancreatitis. It also provides the possibility to study risk factors associated with the development of acute pancreatitis and the severity of the disease. Methods DeCAP is an unselected cohort of consecutive patients with first-time acute pancreatitis at Skåne University hospital, Sweden (2009–2018). It contains 2188 patients with pancreatitis and 10 938 pancreatitis-free individuals matched on sex and age using registry linkage. Medical records were reviewed from index admission to 31 December 2024. Recurrent episodes of acute pancreatitis, including treatment, severity, etiology and development of chronic pancreatitis or diabetes was recorded until death, emigration or end of study. Results The proportion of patients with moderately severe or severe disease differs by etiologies. Patients who experienced moderately severe or severe pancreatitis during their first episode had a fivefold higher likelihood of developing moderately severe or severe disease during a subsequent episode compared with patients whose initial event was mild. Discussion DeCAP combined with the unique national registers in Sweden will be used to to identify risk factors present at the index admission that may influence individual patient trajectories. Improved risk stratification is essential to enable more individualized follow-up strategies aimed at optimizing long-term outcomes while minimizing unnecessary resource utilization. More specifically, we plan to study short- and long-term morbidity, mortality, and recurrence related to individual risk factors. Further, the impact of socio-economic factors and ethnicity on these outcomes will be analyzed.
