ANZ Journal of Surgery最新文献

{"title":"Socioeconomic Disadvantage, Body Mass Index, Rurality and Postoperative Outcomes Following Hip and Knee Arthroplasty in a Regional Australian Cohort.","authors":"Blake Clarke, Margaret Rogers, Richard Page, Kevin Eng, Michael Bullen","doi":"10.1111/ans.70953","DOIUrl":"https://doi.org/10.1111/ans.70953","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic disadvantage, body mass index (BMI) and geographic location influence healthcare access and outcomes. This study examined associations between socioeconomic status, rurality and BMI with outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a regional public referral centre.</p><p><strong>Methods: </strong>A retrospective cohort study of all primary THA and TKA admissions between 2017 and 2024 was performed. Variables included socioeconomic indices (SEIFA), rurality (Modified Monash Model classification), age, sex and BMI. The primary outcome was unplanned 90-day readmission. Secondary outcomes were length of stay (LOS) and intensive care unit (ICU) admission. Multivariate regression was performed. LOS was analysed as a continuous variable, and BMI and socioeconomic indices were modelled continuously to assess dose-response relationships.</p><p><strong>Results: </strong>A total of 3364 admissions were analysed (1862 THA; 1502 TKA). Mean age was 66.63 years (THA) and 69.22 years (TKA). Mean BMI was 30.87 and 34.02, respectively. Increasing BMI demonstrated a dose-response association with 90-day readmission, with a stronger effect in THA (OR 1.08, p < 0.01) than TKA (OR 1.03, p = 0.05). Increasing age and BMI were independently associated with longer LOS in both cohorts (all p < 0.01). Socioeconomic disadvantage was associated with longer LOS in THA (p < 0.01) but not TKA. Higher BMI was associated with ICU admission in both cohorts (THA p = 0.01; TKA p = 0.02).</p><p><strong>Conclusion: </strong>In this regional arthroplasty cohort, obesity was associated with increased readmission and longer LOS, while socioeconomic disadvantage was associated with longer LOS. Rurality was not associated with LOS or readmission.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Do 10 mL Syringe Port Retroperitoneal Access for Staged Minimally Invasive Pancreatic Necrosectomy.","authors":"Katharine Ji, Adrian Fox, Matthew Marshall-Webb","doi":"10.1111/ans.70947","DOIUrl":"https://doi.org/10.1111/ans.70947","url":null,"abstract":"<p><p>Acute necrotising pancreatitis with infected pancreatic necrosis has a significant mortality of up to 23.5%, with survival dependent on achieving a complete necrosectomy. In recent years, several minimally invasive techniques have been developed including laparoscopic and endoscopic approaches, which are feasible, well-tolerated and beneficial for the patient when compared with open surgery. Percutaneous drainage with radiologically guided drains has limited efficacy as pancreatic necrosis is mostly solid tissue, but these drains can guide the surgeon to areas of infected necrosis. We present our experience in utilising 10 mL syringes as ports for retroperitoneal access to perform staged pancreatic necrosectomies, allowing the operator to use both the nephroscope and the gastroscope to visually guide the removal of necrotic tissue, the drainage of infected fluid and the placement of drains. This is a cost-effective technique using widely available equipment and can be easily adopted.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative Pressure Wound Therapy Does Not Reduce Wound Complications Following Simple Mastectomy: A Retrospective Cohort Study.","authors":"Robert Torode, David Walsh, Jonathan Fong","doi":"10.1111/ans.70951","DOIUrl":"https://doi.org/10.1111/ans.70951","url":null,"abstract":"<p><strong>Background: </strong>Negative pressure wound therapy (NPWT) reduces wound complications following oncoplastic breast surgery, yet there is limited evidence supporting its use in mastectomy without reconstruction. This study evaluated the effect of NPWT on post-mastectomy wound complications in a rural Australian centre.</p><p><strong>Methods: </strong>A single centre retrospective cohort study assessed simple mastectomy outcomes between 2020 and 2025. Wounds were grouped by post-operative dressing type (NPWT vs. no NPWT). The primary outcome was a composite of aspirated seroma, haematoma, wound dehiscence, and surgical site infection (SSI). Secondary outcomes were individual wound complications and intervention-related outcomes.</p><p><strong>Results: </strong>The 131 mastectomy wounds were included (NPWT = 59). There was no significant difference in the composite wound outcome between NPWT and no NPWT (62.71% vs. 47.22%; p = 0.077). NPWT had significantly more aspirated seromas (59.32% vs. 40.28%; p = 0.030) but multivariate analysis did not identify a significant association (Multivariate Exp (β) (95% CI): 2.021 (0.958-4.265); p = 0.065). No significant difference was identified in the other secondary outcomes. Diabetes mellitus was independently associated with the composite wound complication (Multivariate Exp (β) (95% CI): 3.349 (1.242-9.031); p = 0.017) and increasing body mass index was associated with SSI (Multivariate Exp (β) (95% CI): 1.064 (1.012-1.119); p = 0.015).</p><p><strong>Conclusion: </strong>NPWT was not associated with reduced wound complications following simple mastectomy. Aspirated seroma was more common for NPWT, but regression analysis found no significant association. A high rate of wound complications poses a significant burden for patients and this regional centre; prospective data is required to determine optimal the way to prevent and manage said complications.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Conflicts of Interest: Are They a Problem?","authors":"Anthony Vo,&nbsp;Henry Woo,&nbsp;Guy J. Maddern","doi":"10.1111/ans.70776","DOIUrl":"10.1111/ans.70776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgeons undertake diverse roles in clinical practice, administration, education, research and innovation. These responsibilities can give rise to conflicts of interest when personal, financial, or professional interests intersect with the fundamental obligations to patient care, research integrity, and ethical conduct. While conflicts of interest are inherent in modern surgical practice, inadequate recognition and management risk undermining ethical decision-making and public confidence in the profession.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A structured literature search was conducted using the Ovid MEDLINE database to identify relevant publications addressing conflicts of interest in surgical practice. Conflict of interest policies from surgical specialty colleges in Australia, Canada, Ireland, the United Kingdom, and the United States of America were also reviewed. Findings were synthesised narratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary of Policies</h3>\u0000 \u0000 <p>Existing policies demonstrate broad consistency in defining conflicts of interest and emphasising disclosure. However, substantial variability exists in the depth of guidance for identifying, evaluating and managing conflicts. Empirical evidence highlights underreporting of conflicts of interest and associations between industry relationships and favourable research outcomes. Practical, context-specific strategies for managing complex or evolving conflicts remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Conflicts of interest are an inherent aspect of modern surgical practice. However, existing policies often lack practical, context-specific guidance to address these conflicts. A structured process incorporating identification, disclosure, risk assessment, management, monitoring, and ongoing transparency and accountability should be adopted to uphold professional integrity, support ethical decision-making, and maintain public trust within surgical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1829-1838"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Subcutaneous Negative Suction Drain on Surgical Site Infection Following Colorectal Surgery: A Systematic Review and Meta-Analysis","authors":"Bishnu Prasad Kandel,&nbsp;Prajjwol Luitel,&nbsp;Amit Yadav,&nbsp;Rukesh Yadav,&nbsp;Sujan Shrestha,&nbsp;Anup Chalise","doi":"10.1111/ans.70659","DOIUrl":"10.1111/ans.70659","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgical site infections (SSIs) are among the most common complications following colorectal surgery. This study aimed to systematically review existing evidence on the outcomes of subcutaneous negative suction drain versus no drain in adults undergoing colorectal surgeries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was conducted to compare the SSI rates between subcutaneous negative suction drain and the no-drain in adults (18 years or older) undergoing colorectal surgery. Randomized controlled trials (RCTs), prospective, or retrospective studies till 2025 reporting use of subcutaneous negative suction drain in elective and emergency colorectal surgeries were included. SSI was defined based on Center for Disease Control and Prevention (CDC) criteria. Results were expressed as Relative Risk (RR) and Confidence interval (CI) of 95%. A <i>p</i> value &lt; 0.05 was considered statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Combined data from 2177 patients across 10 studies (four: RCTs, five: retrospective cohort, and one: prospective cohort) showed a significant reduction in overall SSIs by 60% (RR = 0.40; 95% CI, 0.30–0.53; <i>p</i> &lt; 0.0001) in groups with a subcutaneous negative suction drain compared to those without. There was a significant reduction in superficial SSIs by 58% (RR = 0.42; 95% CI, 0.26–0.66; <i>p</i> = 0.0002). There was no significant reduction in deep SSIs and organ-space SSIs. The included studies were of medium to high quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Subcutaneous negative suction drains reduce overall and superficial SSI after colorectal surgery, but do not affect deep or organ-space infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Originality Statement</h3>\u0000 \u0000 <p>This paper provides updated evidence demonstrating that subcutaneous negative suction drains significantly reduce overall and superficial surgical site infections after colorectal surgery, and acknowledges their limited effect on deep and organ-space infections, supporting selective use.</p>\u0000 \u0000 <p>\u0000 <b>Trial Registration:</b> The study protocol was registered with PROSPERO international prospective register of systematic Reviews (Registration ID: CRD420251012636)</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1867-1879"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Evidence Base Regarding Early Onset Colorectal Cancer in Australia and New Zealand? A Scoping Review","authors":"Tiffany J. Cherry,&nbsp;Dilshan Udayasiri,&nbsp;Ian P. Hayes","doi":"10.1111/ans.70648","DOIUrl":"10.1111/ans.70648","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early onset colorectal cancer (EoCRC), commonly defined as colorectal cancer diagnosed in people under 50 years of age, is increasing in incidence in Australia and New Zealand. The underlying cause of this remains unclear, despite its growing public health importance. The objective of this scoping review was to comprehensively map and synthesise the literature for EoCRC across Australia and New Zealand, focusing on themes and data sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review was performed according to the PRISMA guidance. Inclusion criteria: English language, humans, publications 01/01/2000–31/05/2025, Australian and/or New Zealand patients, studies addressing EoCRC (adenocarcinoma). A systematic literature review was performed: 698 titles and abstracts were screened, 72 full texts were reviewed, with 59 studies included for final analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Studies were mostly derived from national and state-based cancer registries and thus presented results achievable by analysis of these databases: incidence, patient demographics, familial cancer syndromes and genetics, tumour characteristics, treatment, short term outcomes and survival. Direct comparison between studies was difficult due to the heterogeneity of patient groups and outcome measures. Gaps identified in the literature included lack of longitudinal risk factor analysis and detailed clinicopathological data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Australia and New Zealand benefit from the mandatory reporting of colon cancer into central registries. To further progress our understanding of EoCRC, prospectively collected and detailed clinicopathological data are required. Despite relatively small populations, the incidence of colorectal cancer in Australia and New Zealand remains among the highest in the world; insights obtained locally have potential global impact.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1853-1866"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less Than Full-Time Training in General Surgery: Who Benefits and Who Carries the Cost?","authors":"Tess Howard,&nbsp;Josephine de Costa,&nbsp;Grace L. Chew,&nbsp;Michael Issac,&nbsp;Matthew Ng","doi":"10.1111/ans.70808","DOIUrl":"10.1111/ans.70808","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1815-1817"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond “Fast From Midnight”—The New Fasting Norm Is Here","authors":"David Moore,&nbsp;Phuong Markman","doi":"10.1111/ans.70729","DOIUrl":"10.1111/ans.70729","url":null,"abstract":"&lt;p&gt;These authentic quotes from our Consumer Liaison department exemplify a persistent failure in surgical care: the continued adherence to “Fast from Midnight” (FFM). They highlight the unnecessary physiological and psychological harm we subject our patients to by persisting with outdated fasting practice under the guise of safety.&lt;/p&gt;&lt;p&gt;Traditional FFM orders do not result in a lower gastric volume or acidity compared to allowing patients to drink clear fluids on the morning of surgery [&lt;span&gt;1&lt;/span&gt;]. Moreover, a significant minority of fasted elective surgery patients still exhibit a “full stomach” when assessed by pre-operative gastric ultrasound [&lt;span&gt;2&lt;/span&gt;]. Conversely, the harms of prolonged fasting are well documented, including increased thirst, anxiety, and discomfort [&lt;span&gt;3-5&lt;/span&gt;]. Post-operative delirium, a distressing complication especially prevalent among older adults, correlates with the duration of fluid fasting [&lt;span&gt;6&lt;/span&gt;]. In vulnerable populations such as hip fracture patients, complications quadruple when surgery is performed on dehydrated individuals [&lt;span&gt;7&lt;/span&gt;]. Even our youngest patients are not spared; prolonged fasting is linked to greater metabolic and hemodynamic disturbance in infants at time of anesthetic induction [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Since the early 1990s, multiple articles and editorials have advocated for more liberal fasting protocols [&lt;span&gt;9-11&lt;/span&gt;]. These have informed changes in official preoperative fasting guidelines [&lt;span&gt;12-14&lt;/span&gt;]. Recent initiatives such as “Sip til Send”(STS) have demonstrated meaningful reductions in fluid fasting times, without apparent increase in aspiration risk [&lt;span&gt;13&lt;/span&gt;]. Yet, FFM orders stubbornly persist and associated prolonged fasting remains common [&lt;span&gt;15, 16&lt;/span&gt;]. So, how can we end this harmful practice?&lt;/p&gt;&lt;p&gt;In this issue, Dr. Freyer and colleagues report on a quality improvement initiative at The Canberra Hospital [&lt;span&gt;17&lt;/span&gt;]. Their approach combined staff education with enhanced Electronic Medical Record functionality to implement a preoperative fasting protocol aligned with current guidelines. Building on similar work at The Royal Melbourne Hospital, their post-implementation audit showed that 65 of 149 fasting episodes (47%) complied fully with best-practice guidelines. These gains were driven by reduced inappropriate use of Nil by Mouth (NBM) and obsolete FFM orders. A significant decrease in unnecessary intravenous fluids prescriptions was also noted. A contemporaneous global supply shortage of intravenous fluids reinforced adherence to the protocol—never let a good crisis go to waste.&lt;/p&gt;&lt;p&gt;Adoption of the new protocol was associated with financial, environmental and time benefits, as well as shorter fasting durations. The discussion summarizes the safety and advantages of reduced fasting protocols, while acknowledging the need for further progress to benefit the significant cohort of patients still burdened by out","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1809-1811"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70729","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of Adult Prediction Models for Complicated Appendicitis After Contrast-Enhanced Computed Tomography: A Single-Centre Study","authors":"Kim-Long Le,&nbsp;Dung Anh Nguyen,&nbsp;Tri-Nhan Pham,&nbsp;My-Tran Trinh,&nbsp;Minh-Quang Tran,&nbsp;Phu-Cuong Pham,&nbsp;Nguyen Thi Nguyen,&nbsp;Nguyen-Khoi Le","doi":"10.1111/ans.70799","DOIUrl":"10.1111/ans.70799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preoperative distinction between uncomplicated and complicated appendicitis is important when treatment pathways diverge, including non-operative management for adults. Several adult prediction models exist, but validation remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-centre validation study using a dataset from Nhan Dan Gia Dinh Hospital. Adults undergoing appendectomy after contrast-enhanced computed tomography were included. Complicated appendicitis was the primary outcome. Atema 2015, the Appendicitis Severity Index and Mori 2024 were prespecified for formal external validation. Because the pain score was unavailable, SAS 2.0 was not formally validated; instead, a modified SAS 2.0 using a surrogate abdominal examination variable was explored. Discrimination was assessed with area under the receiver operating characteristic curve, and threshold metrics at cut-offs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort comprised 496 adults; 200 (40.3%) had complicated appendicitis. Mori 2024 showed the highest discrimination (area under the receiver operating characteristic curve 0.783, 95% confidence interval: 0.741–0.826), followed by Atema 2015 (0.760, 0.715–0.804) and the Appendicitis Severity Index (0.731, 0.686–0.776). Mori outperformed the Appendicitis Severity Index (<i>p</i> = 0.0146). At published cut-offs, sensitivity/specificity were 51.6%/89.7% for Atema, 22.0%/98.6% for the Appendicitis Severity Index and 75.0%/65.4% for Mori. In 474 complete cases, modified SAS 2.0 achieved an apparent area under the receiver operating characteristic curve of 0.850 and optimism-corrected area under the curve of 0.833.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this restricted-spectrum cohort, Mori performed best among the formal models, whereas the Appendicitis Severity Index was most specific but poorly sensitive. None of the formal models should be used alone to exclude complicated appendicitis in this setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1927-1933"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training for Rectal Resection in the Era of Total Neoadjuvant Therapy and Organ Preservation: Safeguarding Competence as Operative Casemix Evolves","authors":"Rathin Gosavi,&nbsp;Stephen Bell,&nbsp;Satish Warrier,&nbsp;William Teoh,&nbsp;Paul McMurrick,&nbsp;Vignesh Narasimhan","doi":"10.1111/ans.70679","DOIUrl":"10.1111/ans.70679","url":null,"abstract":"&lt;p&gt;The management of rectal cancer has changed substantially over the past decade. Total neoadjuvant therapy (TNT), response-adapted protocols and structured watch-and-wait programmes are now embedded in routine practice, enabling a growing proportion of patients to avoid rectal resection. Trials such as OPRA [&lt;span&gt;1, 2&lt;/span&gt;], together with international prospective cohorts [&lt;span&gt;3&lt;/span&gt;], have demonstrated durable oncological outcomes in selected responders, shifting definitive surgery from routine to selective.&lt;/p&gt;&lt;p&gt;This evolution offers clear benefits for patients, including reduced morbidity, preserved function and treatment pathways more aligned with quality-of-life priorities. For surgical training, however, it presents a challenge. Rectal resection remains a technically demanding procedure with narrow safety margins, yet operative exposure is declining while case complexity is increasing [&lt;span&gt;4&lt;/span&gt;]. The resections that do proceed are increasingly weighted toward incomplete responders [&lt;span&gt;5&lt;/span&gt;], post-radiotherapy fibrosis, distorted pelvic planes, threatened margins and salvage after regrowth, scenarios that demand advanced technical judgement and capabilities beyond standard total mesorectal excision (TME) dissection [&lt;span&gt;6, 7&lt;/span&gt;]. The index operation has become less frequent and more difficult, while expectations of safety and proficiency remain unchanged.&lt;/p&gt;&lt;p&gt;Traditional training models rely on repeated exposure, progressive autonomy and whole-case experience over time. These assumptions may become increasingly untenable in low-volume environments. This Perspective outlines the implications of contemporary rectal cancer treatment for surgical education and proposes practical strategies to safeguard competence in TME and restorative pelvic surgery.&lt;/p&gt;&lt;p&gt;The clinical rationale for TNT and organ preservation is well established. Delivering systemic therapy upfront, often combined with radiotherapy, increases the likelihood of tumour regression and enables response-based treatment decisions. Randomised TNT trials, including RAPIDO, PRODIGE 23 and STELLAR [&lt;span&gt;8-10&lt;/span&gt;], have supported broader adoption of intensified neoadjuvant sequencing and response-adapted management. However, longer-term follow-up from RAPIDO demonstrated higher locoregional failure in the TNT arm [&lt;span&gt;11&lt;/span&gt;], underscoring that these strategies are not oncologically equivalent across all endpoints. Structured watch-and-wait programmes have matured, with defined imaging, endoscopic and clinical surveillance protocols supporting non-operative management in carefully selected patients. Local excision may provide an additional organ-preserving option in selected responders [&lt;span&gt;12&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Together, these approaches have contributed to a measurable reduction in rectal resection rates. In a Dutch national cohort, surgical resection rates for non-metastatic rectal cancer fell from 85% in 2013 to 73% in 2018 [&lt;span&gt;13&lt;/span&gt;]. In t","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 7-8","pages":"1818-1821"},"PeriodicalIF":1.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}