BackgroundThe optimal timing of contralateral symmetrization surgery (SS) in unilateral autologous breast reconstruction remains under debate. This study compared short- and long-term patient-reported outcomes between women undergoing contralateral SS during the index breast reconstruction surgery and those undergoing contralateral SS as a separate secondary surgery.MethodsA quantitative study evaluating clinical and patient-reported outcomes was conducted using prospectively collected BREAST-Q™ questionnaires and retrospectively collected patient data. All patients undergoing unilateral abdominal-based free flap breast reconstruction at Uppsala University Hospital between January 2016 and December 2023 were considered for study participation. Those who had undergone contralateral SS or were scheduled for SS on the contralateral breast at a later date and who had completed preoperative and/or postoperative patient surveys were included in the study.ResultsIn all, 91 patients were included in the study. Index breast reconstruction was performed immediately at the time of mastectomy in seven patients (7.7%) and as delayed reconstruction in 84 patients (92.3%). Forty-six patients (50.5%) underwent simultaneous contralateral SS and 45 patients (49.5%) underwent secondary contralateral SS. Among women undergoing delayed breast reconstruction, the difference in satisfaction with breasts at baseline and 3 months after the index reconstruction, was significantly higher among those undergoing simultaneous contralateral SS than among those waiting for a secondary contralateral SS (P = 0.011). Two years after the index reconstruction, when all patients were symmetrized, there was no difference in satisfaction with breasts between the two groups. There was a moderate increase in operation time at index breast reconstruction between the simultaneous and secondary contralateral SS groups (mean(s.d.) 371.8(79.1) versus 337.6(61.0) minutes, respectively; P = 0.036). There was no significant difference in the overall complication rate between the two groups (P = 0.094). As expected, the number of additional operations under general anaesthesia following the index breast reconstruction was significantly higher in the secondary contralateral SS group (P = 0.007).ConclusionSimultaneous contralateral SS may increase short-term satisfaction with breasts and lead to fewer additional surgeries requiring general anaesthesia. However, in the long term (2-year follow-up), patient satisfaction with breasts was not affected by the timing of the contralateral SS.

Around 30 000 patients undergo emergency laparotomy in the UK each year, and a similar number of patients undergo open cardiothoracic surgery. Surgical site infection is a common complication associated with increased morbidity, prolonged hospital stay, and higher healthcare costs. Negative-pressure wound therapy has been proposed as a prophylactic strategy to reduce wound complications, but trial evidence has been inconsistent. This systematic review and meta-analysis was carried out using PRISMA guidelines and was registered prospectively in PROSPERO (CRD420251010516). A literature search was carried out in March 2025 (updated December 2025), and titles and abstracts were screened against predefined inclusion criteria. Trials assessing patients undergoing open thoracic or abdominal surgery for any indication in adult patients assessing the risk of surgical site infection as an outcome were included. Quality assessment was performed using Cochrane's risk-of-bias 2 tool. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval of 95% and are presented as forest plots. Some 12 427 patients across 45 randomized trials in abdominal and thoracic surgery were included for analysis. Negative-pressure wound therapy significantly reduced surgical site infection compared with standard dressings (odds ratio (OR) 0.53, 95% confidence interval 0.42 to 0.66). The effect was consistent across commercial devices (PICO™ and Prevena™). Negative-pressure wound therapy was associated with shorter hospital stay (mean difference -1.67 (95% confidence interval -3.19 to -0.16) days), but not with reduced risk of organ/space infection (OR 0.92, 0.67 to 1.25), wound dehiscence, or reoperation. Only three studies included thoracic surgery and no significant difference in surgical site infection was found (OR 0.44, 0.00 to 45.25). Publication bias was detected; trim-and-fill analysis attenuated but did not eliminate the benefit (adjusted OR 0.70, 0.54 to 0.90). Adverse events and patient-reported outcomes were reported infrequently, and showed no consistent differences. Negative-pressure wound therapy was associated with a nearly 50% reduction in SSI and shorter hospital stay after open abdominal surgery, with consistent benefit across device types. However, evidence of publication bias, and limited long-term and patient-reported outcome data suggest that effect size may be overestimated. Selective use in high-risk patients is supported.

BackgroundBreast cancer (Bc) is the leading cause of cancer-related death in women. In many patients, BC liver metastases (BCLM) are associated with short survival. The aims of this study were to investigate the risk of and time to BCLM in each BC surrogate subtype, and to determine the incidence of BCLM in a population-based setting.MethodsThe Swedish national breast cancer registry identified patients with Bc in a regional cohort from 2009 to 2018. The cohort was followed until January 2023. Cox regression analysis was used to determine the risk of BCLM for each subtype. Kaplan–Meier estimates determined the probability of BCLM for each subtype over time.ResultsIn all, 7292 patients with Bc were included in the study. Distant metastases developed in 755 patients (10.4%); of these, 345 (45.7%) developed BCLM. The BCLM incidence rate was 8 per 1000 person-years. Only 13 patients had oligometastases isolated to the liver. Triple-negative, non-luminal human epidermal growth factor receptor 2 (HER2)-positive and luminal B cancers had the highest risk of BCLM. T category, nodal status, and Nottingham histological grade III were also strongly associated with BCLM. The median time from Bc diagnosis to BCLM was 36 months. Patients with HER2-positive BC subtypes developed BCLM early, at a median of only 9 months.ConclusionBc subtype is correlated to the risk and timing of BCLM development. BCLM are common in advanced Bc, but isolated oligometastases are rare.

BackgroundEarly postoperative mobilization is an important component of enhanced recovery after surgery protocols, which aim to improve postoperative outcomes. This narrative review explores the historical evolution, physiological impact, and clinical advantages of early postoperative mobilization.MethodsThe Embase, MEDLINE, and PubMed databases were searched, without time restrictions, for studies related to postoperative immobilization and mobilization. Randomized clinical trials, observational studies, systematic reviews, meta-analyses, and clinical guidelines pertaining to adult surgical patients were reviewed, aiming to summarize the historical background, the pathophysiology of immobilization, the clinical outcomes of early postoperative mobilization, anaesthetic aspects, adverse events, limitations of the current evidence, and key barriers.ResultsExtended postoperative immobilization was consistently linked with negative physiological outcomes, including muscle atrophy, insulin resistance, venous thromboembolism, and postoperative pulmonary complications. Several studies indicated that each additional day of postoperative bed rest was associated with a nearly threefold increase in the risk of postoperative pulmonary complications, and remaining on bed rest for more than 3 days was associated with a 2.7-fold higher risk of postoperative pneumonia. Conversely, early postoperative mobilization was associated with shorter hospital length of stay, with reductions of up to 34% reported in some surgical populations, and improved functional recovery. However, the effects of early postoperative mobilization on morbidity, quality of life, and mortality were inconsistent across studies.ConclusionsEarly postoperative mobilization provides significant functional and physiological advantages. However, the strength of evidence supporting its impact on clinical outcomes varies according to surgical subspecialities. To improve implementation and reinforce evidence-based recommendations, future research should focus on standardized definitions of early postoperative mobilization, consistent outcome measures, and higher-quality, subspeciality-specific studies.

BackgroundMalignant bowel obstruction in patients with stage IV gastrointestinal cancer represents a challenging scenario, with a lack of patient-centred outcome data to guide decisions. This study evaluated the association between days at home, and malignant bowel obstruction palliation treatment strategy in this subgroup of patients.MethodsThis population-based retrospective cohort study included adults with stage IV gastrointestinal cancer admitted for malignant bowel obstruction between 2010 and 2019. Patients with stage IV gastrointestinal cancer treated with curative intent were excluded. The primary exposure was treatment strategy at first admission with malignant bowel obstruction divided into surgical, procedural (percutaneous or endoscopic), and supportive care. The primary outcome of interest was days at home over 90 days. Multivariable quantile regression was used to evaluate the association between treatment strategy and days at home over 90 days adjusted for cancer and patient factors. Quantile plots were used to examine this association across the distribution of days at home over 90 days.ResultsOf 12 923 patients admitted, 4642 were selected: 2076 (44.7%) received surgical, 310 (6.7%) procedural, and 2256 (48.6%) supportive care. Those who had surgical treatment had the highest median days at home over 90 days of 67 (interquartile range 23–80) days, followed 45 (7–78) days with procedural treatment, and 31 (0–76) days with supportive care. After adjusting for patient and cancer factors, surgical treatment was associated with an increase in median days at home over 90 days of 20 (95% confidence interval 15–24) days and procedural treatment with an increase of 14 (6–22) days. The directionality of these findings was stable across the distribution of days at home over 90 days, and stable in sensitivity analysis after exclusion of deaths.ConclusionSurgical and procedural treatment were associated with increased days at home over 90 days. These findings can support decision-making and expectation setting in patients eligible for surgical and procedural treatments.

BackgroundThe increasing detection of non-palpable breast lesions has made accurate preoperative localization essential to optimize breast-conserving surgery. Although multiple localization methods exist, there is still a lack of robust, large-scale, multicentre evaluations comparing different techniques.MethodsThe LOCALIZATION01 study compares real-world data from 13 breast units in Italy and Switzerland on the impact of localization techniques on breast-conserving surgery for non-palpable lesions between 2016 and 2024. Four localization techniques were compared: wire-guided (WGL), radio-guided (ROLL), magnetic seed (MSL), and carbon (CL). The main outcomes were margin status, calculated resection ratio, postoperative complications, and surgical time. Subgroup analyses were performed for body mass index, lesion morphology and histopathology.ResultsIn total, 3241 patients were enrolled (ROLL 985, MSL 592, WGL 1079, and CL 585). ROLL achieved the highest rate of negative surgical margins, significantly outperforming MSL, WGL, and CL (97.5% versus 94.7% versus 94.5% versus 90.6%, respectively; P < 0.05). CL was associated with the highest postoperative complications rate (16.7%) versus ROLL (4.1%), MSL (4.5%), and WGL (2.1%) (P < 0.0001). The surgical time for MSL was significantly shorter when compared with WGL (46 versus 70 minutes (min); P < 0.0001) and CL (55 min; P < 0.0001). WGL had the most favourable calculated resection ratio (2.4), followed by MSL (2.6), ROLL (2.7), and CL (3.0). Multivariable analysis identified CL as an independent predictor of positive margins (odds ratio 1.82; P = 0.004), whereas ROLL was protective (odds ratio 0.45; P = 0.009).ConclusionROLL and MSL outperformed WGL and CL across multiple endpoints. CL data revealed objective limitations that suggest caution in its use. A personalized approach considering lesion morphology, body mass index, and logistics is recommended.

BackgroundAchalasia is rare disease in children and young people (CYP) that causes significant symptoms and often requires invasive interventions. There is currently no consensus on the optimal management strategy. This study investigated the current management and outcomes of CYP with achalasia in the UK.MethodsA retrospective study was conducted of CYP (aged ≤ 16 years) diagnosed with achalasia between 2011 and 2021 in the UK. The study was co-designed with the patient group Achalasia Action. Data were collected from patient records. The primary outcome was treatment success.ResultsIn all, 126 patients were included from 13 UK centres; 64 of the patients (50.8%) were male and the median age at diagnosis was 12 (interquartile range (i.q.r.) 9–14) years. The most frequent presenting features were dysphagia (73.8%), vomiting (53.2%), and weight loss (38.9%). The median time from symptom onset to diagnosis was 11 (i.q.r. 6–24) months. Treatment success was achieved in 55 of 120 patients (45.8%) after first-line intervention. Heller’s cardiomyotomy (HCM) as the first-line intervention had a higher success rate than endoscopic balloon dilatation (EBD; (52 of 72 (72%) versus 3 of 48 (6%), respectively; P < 0.001). However, overall HCM had a higher frequency of complications than EBD (17 of 98 (17%) versus 3 of 57 (5%), respectively; P = 0.045). In the entire cohort, 53% of patients reported symptoms at the 1-year follow-up.ConclusionsVariation exists in the management of CYP with achalasia in the UK. The highest rates of treatment success were associated with HCM. Many CYP remain symptomatic after treatment and require multiple interventions. The present data can be used to inform management decisions in CYP with achalasia.

BackgroundRecent improvements in pancreatic surgery outcomes have highlighted the relevance of comprehensive quality measures, including textbook outcome. The aim of this study was to evaluate textbook outcome in patients with pancreatic neuroendocrine tumours undergoing surgical resection.MethodsAll patients undergoing surgery for pancreatic neuroendocrine tumours between 2010 and 2023 were included. Textbook outcome was defined as the absence of severe morbidity (Clavien–Dindo grade ≥ III), pancreatic fistula, bile leakage, haemorrhage, readmission, and no death. Logistic regression analysis was used to identify risk factors and Kaplan–Meier survival analysis to compare disease-free and overall survival.ResultsA total of 622 patients underwent surgery for pancreatic neuroendocrine tumours. Major morbidity occurred in 192 patients (30.9%) with an in-hospital mortality rate of 2.6% (16 patients). Rates of postoperative pancreatic fistula, haemorrhage, and readmission were 21.5, 6.4, and 10.3% respectively. Overall, a textbook outcome was achieved in 399 patients (64.1%), with a higher rate after organ-sparing versus formal resections (89 (74.8%) versus 310 (61.6%); P = 0.008). Risk factors for non-textbook outcome were older age (odds ratio 1.52, 95% confidence interval 1.05 to 2.20; P = 0.028), higher body mass index (odds ratio 1.61, 95% CI 1.15 to 2.25; P = 0.006), American Society of Anesthesiologists grade ≥ III (odds ratio 1.63, 95% CI 1.14 to 2.35; P = 0.008), and longer duration of surgery (odds ratio 1.69, 95% CI 1.17 to 2.45; P = 0.006). Patients with a textbook outcome had higher 5-year rates of disease-free (73 versus 67%; P = 0.025) and overall (88 versus 78%; P < 0.001) survival than those with a non-textbook outcome. This effect was confirmed in patients with non-functioning pancreatic neuroendocrine tumours (overall survival: 85 versus 77%; P = 0.003). In multivariable analysis, textbook outcome remained an independent predictor of survival.ConclusionA textbook outcome was achieved in most patients undergoing pancreatic surgery for pancreatic neuroendocrine tumours and was associated with improved long-term survival. Textbook outcome may serve as a quality control and prognostic indicator in surgery for pancreatic neuroendocrine tumours.