Early-onset gastrointestinal cancers: comprehensive review and future directions 

This narrative review evaluated early-onset (EO) gastrointestinal (GI) cancers, focusing on colorectal, oesophagogastric and pancreatic cancers. The authors concluded there had been a consistent rise in incidence and EO GI cancers represent clinically distinct disease entities with unique challenges in screening, management and survivorship. A better understanding of underlying aetiologies, optimised screening strategies and improved survivorship support are necessary. 

Char SK, O’Connor CA, Ng K. BJS 2025; 112(7), znaf102. https://doi.org/10.1093/bjs/znaf102.

Current treatment for symptomatic uterine fibroids: available evidence and therapeutic dilemmas

This review offered an evaluation of the current treatments for symptomatic uterine fibroids, including: uterine artery embolisation; MRI-guided, high-intensity, focused ultrasound; laparoscopic radiofrequency ablation; transcervical radiofrequency ablation; ulipristal acetate; and oral gonadotropin-releasing hormone antagonists with add-back therapy. It proposed a practical flowchart to help clinicians navigate treatment decisions. This review also identified the knowledge gaps that contribute to the specification of the fibroid research agenda.

de Smit NS, de Lange ME, Boomsma MF, Huirne JA, Hehenkamp WJK. Lancet 2025; 406(10498): 91–102.

Paravertebral versus epidural analgesia in minimally invasive esophageal resection (PEPMEN)

This Dutch trial randomised 192 patients undergoing minimally invasive esophagectomy to receive epidural or paravertebral analgesia. The quality of the recovery scores on day three was no different between the groups. No significant differences were found in postoperative complications or hospital/intensive care unit stay. The authors concluded that both techniques are effective and can be offered in clinical practice.

Feenstra, ML, Kooij CD, Eshuis WJ, et al. Ann Surg 2025; 282(1): 29–26. DOI: 10.1097/SLA.0000000000006551.

Omitting completion axillary lymph node dissection in breast cancer patients with  sentinel lymph node micrometastases undergoing mastectomy

The SENOMIC cohort trial included 407 patients who underwent mastectomy without nodal radiotherapy for breast cancer and SLN micrometastases. The five-year event-free and cancer-specific survivals were 86.8% and 97.0% respectively. Isolated axillary recurrence was found in 14 patients (3.1%). The authors concluded the event-free survival after omission of cALND in these patients was excellent. Long-term follow-up is important to validate the safety, but omission of cALND should be regarded as routine care.

Andersson Y, Bergkvist L, Rydén L. BJS 2025; 112(6): znaf111. https://doi.org/10.1093/bjs/znaf111.

The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials 

This meta-analysis evaluated seven trials with 12,134 patients. There was no significant difference in the overall risk of VTE between aspirin and LMWH cohorts. In sub-group analysis, there was a higher PE risk, and a higher risk of VTEs, following total knee arthroplasty in the group receiving aspirin. The authors concluded these results suggest the inferiority of aspirin compared with LMWH following such procedures.

Salman LA, Alahtamouni SB, Khatkar H, et al. Knee Surg Sports Traumatol Arthrosc 2025; 33(5): 1605. https://doi.org/10.1002/ksa.12456.

Endovascular treatment of stroke due to medium-vessel occlusion

This randomised controlled trial assigned 530 patients with acute ischemic stroke due to medium-vessel occlusion, who presented within 12 hours, to receive endovascular thrombectomy (EVT) plus usual care or usual care alone. Most patients (84.7%) had primary occlusions in a middle-cerebral-artery branch. A modified Rankin score of zero or one at 90 days occurred in 41.6% in the EVT group and 43.1% in the usual-care group. Mortality at 90 days was 13.3% in the EVT group and 8.4% in the usual-care group. The authors concluded that endovascular treatment did not lead to better outcomes at 90 days than usual care. 

Goyal M, Ospel JM, Ganesh A, et al. N Engl J Med 2025; 392(14): 1385–1395.

The effect of timing of emergency cholecystectomy for acute cholecystitis on peri-operative outcomes 

This national registry study looked at 3,585 patients who underwent emergency cholecystectomy for acute cholecystitis. Only 55.9 % were performed within 72 hours of admission. Younger, female and less co-morbid patients were more likely to be operated on earlier. Prolonging ‘time to theatre’ beyond 72 hours was associated with a stepwise deterioration in outcomes across a wide variety of measures.

Kehoe JD, O’Connell R, Linehan E, et al. Surgeon 2025. [In press]. https://doi.org/10.1016/j.surge.2025.06.004. 

Roux-en-Y gastric bypass, adjustable gastric banding or sleeve gastrectomy for severe obesity (By-Band-Sleeve)

This UK trial randomised 1,351 patients to gastric bypass, gastric band or sleeve gastrectomy. 68% in the gastric bypass group, 25% in gastric band group and 41% in the sleeve gastrectomy group achieved at least 50% excess weight loss. The authors concluded that Roux-en-Y gastric bypass and sleeve gastrectomy were more effective than gastric banding. They recommended patients are advised to have Roux-en-Y gastric bypass. If contraindicated or unfeasible, sleeve gastrectomy should be offered. 

By-Band-Sleeve Collaborative Group. Lancet Diabetes Endocrinol 2025; 13(5): 410–426.

Risk factors and predictors of thyroid cancer in patients with thyroid nodules

This systematic review identified 77 studies involving 193,599 patients. Factors significantly associated with thyroid cancer included male, younger age, higher BMI, family history, radiation history, Hashimoto’s thyroiditis, higher TSH, higher thyroid peroxidase antibody, and higher thyroglobulin antibody. The authors concluded there was potential to include these factors with ultrasound and cytology to differentiate between benign and malignant nodules and reduce the need for diagnostic thyroidectomy.

Edafe O, Leong WS, Sisley K, Balasubramanian SP. BJS 2025; 112(9): znaf078.002. https://doi.org/10.1093/bjs/znaf078.002.

The incidence and significance of incidental findings on pre-operative CT planning scans for hip and knee robotic arthroplasty surgery

In this article, 1,404 CT arthroplasty planning scan reports were reviewed. 42.2% had incidental findings, including 17.4 % that were graded “further action may be considered” and 1.1% “urgent action required for potential malignancy”. The authors concluded that all CT planning scans for robotic arthroplasty should be reported by a radiologist due to the high incidence of significant incidental findings.

Rankin I, Dixon J, McGrane C, et al. Surgeon 2025; 23(4): 199–203.