Final follow-up from the UK Multicentre Aneurysm Screening Study (MASS)

Authors report the final follow-up of a UK aortic aneurysm screening trial in which some 67,770 men were enrolled. Over 13 years, there were 224 AAA-related deaths in the screening group and 381 in the control group, a 42% reduction. There was also an overall reduction in all-cause mortality of 3%.

Thompson SG, Ashton HA, Gao L, et al. Br J Surg 2012; b1649.

Long-term outcomes of the Australasian Laparoscopic Colon Cancer Study Trial

In this study, 601 patients with potentially curable colon cancer were randomised to receive laparoscopic colorectal resection or open colorectal resection. Patients were followed for a median of five years. There were no significant differences between the LCR and OCR groups in five-year follow-up of overall survival (77.7% vs 76.0%), recurrence-free survival (72.7% vs 71.2%), or freedom from recurrence (86.2% vs 85.6%). Authors conclude that LCR was not inferior to OCR in direct measures of survival and disease recurrence.

Bagshaw P, Allardyce F, Frampton A. Ann Surg 2012; 256(6): b915.

Endoscopic vein harvesting for coronary artery bypass grafting: A systematic review

This meta-analysis identified 27,789 patients who underwent saphenectomy by endoscopic (46%) or conventional technique (54%). It reported that endovascular vein harvest reduces leg wound infections, pain, and hospital stay without increasing the midterm risk for vein graft failure, MI, or mortality.

Deppe AC, Liakopoulos OJ, Choi YH. J Surg Res. 2012 [Epub ahead of print].

Transfusion strategies for acute upper gastrointestinal bleeding

This study randomised 921 patients with severe acute upper gastrointestinal bleeding to a restrictive strategy (transfusion when the hemoglobin level fell below 7g/dl) or a liberal strategy (transfusion when the hemoglobin fell below 9g/dl). Fifty-one per cent assigned to the restrictive strategy did not receive transfusions compared with15% assigned to the liberal strategy. The probability of survival at six weeks was higher in the restrictive-strategy group 95% vs 91%. Benefit was seen for patients with peptic ulcer disease and those with Child-Pugh class A / B cirrhosis.

Villanueva C, Colomo A, Bosch A, et al. N Engl J Med 2013; 368:b11.

Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK

Authors used the UK transplant registry (2005-2010) to select a cohort of 6,490 first-time recipients of deceased-donor kidneys for transplantation. Three-year graft survival showed no difference between circulatory-death (n=1768) and brain-death (n=4127) groups. Authors found that kidneys from older circulatory-death donors have equivalent graft survival to kidneys from brain-death donors in the same age group, and are acceptable for transplantation. However, circulatory-death donor kidneys tolerate cold storage less well than do brain-death donor kidneys. Authors concluded that this finding should be considered when developing organ allocation policy.

Summers DM, Johnson RJ, Hudson A, et al. Lancet. 2012 Dec (Epub ahead of print).

Repeating conservative surgery after ipsilateral breast tumour reappearance: criteria for selecting the best candidates

This study retrospectively evaluated 161 patients who underwent a second breast-conserving surgery (BCS) for ipsilateral breast tumour recurrence (IBTR) after BCS and whole-breast radiotherapy. The best candidates for a second BCS were those with small (?2cm) and late (time to IBTR >48 months) recurrence. The five-year cumulative incidence of a further local reappearance of the tumour after repeating BCS was 15.2% in this group of patients.

Gentilini O, Botteri E, Veronesi P, et al. Ann Surg Oncol 2012; 19(12): b3771.

Randomised clinical trial on the effect of coffee on postoperative ileus following elective colectomy

This multicentre randomised trial assigned 80 patients undergoing elective open or laparoscopic colectomy to receive either coffee or water after the procedure (100ml three times daily). In intention-to-treat analysis, the time to the first bowel movement was significantly shorter in the coffee arm (60·4 vs. 74·0 hours). Length of hospital stay and morbidity were comparable in the two groups. Authors concluded that coffee consumption after colectomy was safe and was associated with a reduced time to first bowel action.

Müller SA, Rahbari NN, Schneider F, et al. Br J Surg 2012; 99(11):b1530.