ANZ Journal of Surgery最新文献

{"title":"Computed Tomography-Derived Abdominal Aortic Calcification Independently Predicts Survival in Rectal Cancer Surgery: A Retrospective Cohort Study.","authors":"Michael Rouse, Arwa Hadi, Yumna Kaleem, Alex Besson, Fiona Reid, Justin M Yeung","doi":"10.1111/ans.71025","DOIUrl":"https://doi.org/10.1111/ans.71025","url":null,"abstract":"<p><strong>Background: </strong>Contemporary rectal cancer treatment pathways remain predominantly guided by tumour-related characteristics, including stage and histopathology, with comparatively limited objective assessment of physiological reserve for treatment planning. Aortic calcification represents a potential imaging biomarker reflecting systemic vascular disease, chronic inflammation and physiological reserve. We evaluated computed tomography (CT)-derived abdominal aortic calcification as a prognostic imaging biomarker for postoperative outcomes and long-term survival.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the prospectively maintained Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) of rectal cancer patients treated between 2013 and 2022. Pre-treatment staging CT was subjected to semi-automated volumetric quantification of calcium using 3D Slicer software. Calcification volume was assessed segmentally at vertebral levels L1-L4 and at the iliac vessels. Primary outcomes were major postoperative complications (Clavien-Dindo ≥ III) and overall survival. Cox proportional hazards modelling was performed using a prespecified parsimonious multivariable model.</p><p><strong>Results: </strong>A total of 174 patients were included in the analysis. Increasing calcification burden demonstrated no statistically significant association with major postoperative complications (OR 1.09 per 1000-unit increase; 95% CI 0.99-1.19; p = 0.07). Increasing calcification independently predicted worse 5-year survival after multivariable adjustment (HR 1.17 per 1000-unit increase ([CI 1.08-1.28, p = 0.001]). Kaplan-Meier analyses showed separation between calcification groups, although dichotomised analyses did not reach statistical significance.</p><p><strong>Conclusion: </strong>Aortic calcification independently predicts long-term survival following rectal cancer surgery but not short-term postoperative complications. Quantitative CT-derived calcification assessment may provide a rapid, objective imaging biomarker that reflects physiological reserve and represents a potential adjunct to future risk stratification pathways.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223314","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":"The Effect of Post-Operative Localised Tissue Warming on Surgical Outcomes: A Systematic Review.","authors":"Thiviya Sivakanthan, Kwaku Duah-Asante, Ife Oledajo, Tooba Arif, Saahil Mehta, Hadyn K N Kankam","doi":"10.1111/ans.71017","DOIUrl":"https://doi.org/10.1111/ans.71017","url":null,"abstract":"<p><strong>Background: </strong>Post-operative wound complications remain a significant source of morbidity following surgery, yet evidence-based strategies targeting the local wound environment in the post-operative period remain scarce. Local surgical site warming may represent a simple, low-cost intervention to improve outcomes by enhancing tissue perfusion, oxygenation, and immune function. This cross-specialty systematic review evaluated the safety and efficacy of post-operative local surgical site warming.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review was prospectively registered on PROSPERO. PubMed, Embase, and the Cochrane Library were searched from inception to April 2026. Studies investigating clinical outcomes following the application of heat directly to the surgical site post-operatively were included.</p><p><strong>Results: </strong>The primary literature search returned 20 076 articles. Following de-duplication and title/abstract and full-text screening, thirteen studies, with a total of 981 patients, were included. In plastic surgery, post-operative local warming increased microcirculatory blood flow by up to 103%, improved tissue oxygen saturation and local innate immunity, and was associated with superior free flap survival rates. Across general surgery and gynaecology, warming significantly improved wound healing parameters and subcutaneous oxygen tension, whilst also reducing post-operative pain and analgesic consumption. No thermal injuries or serious adverse effects were reported in any study.</p><p><strong>Conclusions: </strong>Post-operative local surgical site warming is safe and consistently improves tissue perfusion, oxygenation, and early wound healing, with compelling findings in soft tissue reconstruction. This review provides a foundation for prospective trials evaluating warming as an adjunct to standard post-operative wound care.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223250","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":"Neuroendoscopic-Assisted vs. Conventional Burr-Hole Drainage for Septated Chronic Subdural Hematoma: A Comparative Cohort Study on Efficacy and Long-Term Functional Outcomes.","authors":"Wentao Lai, Guanlin Huang, Chuanyun Liu, Jing Hu, Xinyun Ye","doi":"10.1111/ans.71008","DOIUrl":"https://doi.org/10.1111/ans.71008","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (CSDH) is prevalent in the elderly. Its septated variant poses a significant surgical challenge, as conventional burr-hole drainage often yields suboptimal results due to incomplete evacuation. Neuroendoscopy has emerged as a potential solution, but robust comparative evidence is lacking.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, we enrolled 100 patients with radiologically confirmed septated CSDH. Fifty-two underwent neuroendoscopic-assisted evacuation (Endoscopic Group), and 48 underwent conventional burr-hole drainage (Burr-Hole Group). We compared intraoperative metrics (operative time, blood loss, irrigation volume, hematoma evacuation rate), drainage duration, recurrence, and neurological/functional outcomes (mRS, NIHSS, ADL, GOS) at 6 months.</p><p><strong>Results: </strong>The Endoscopic Group demonstrated a significantly higher hematoma evacuation rate (89.96% vs. 81.64%, p < 0.001) with substantially less irrigation fluid (587 vs. 1538 mL, p < 0.001), despite a longer operative time (68.34 vs. 47.52 min, p < 0.001). The endoscopic approach also led to shorter drainage retention (median 1.0 vs. 2.0 days, p < 0.001) and a significantly reduced recurrence rate (0% vs. 12.5%, p = 0.010). At 6 months, the Endoscopic Group showed superior outcomes, evidenced by more favorable mRS distributions (p = 0.004), lower NIHSS scores (7.42 vs. 8.26, p = 0.006), higher ADL scores (92.78 vs. 84.45, p < 0.001), and better GOS ratings (p = 0.014). Overall complication rates were comparable (5.8% vs. 14.6%, p = 0.134).</p><p><strong>Conclusion: </strong>Neuroendoscopic-assisted burr-hole evacuation is a highly effective strategy with a favorable safety profile for septated CSDH. By ensuring more complete evacuation via direct septal disruption, this technique facilitates faster recovery, significantly lowers recurrence, and improves long-term functional outcomes, justifying the longer operative time.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206519","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":"Pancreatic Invasion in Distal Cholangiocarcinoma Is a Poor Prognostic Factor: A New Approach Integrating Tumor Depth of Invasion.","authors":"Hirokazu Ogasawara, Tadashi Yoshizawa, Kenta Ogasawara, Daiki Kasai, Shintaro Goto, Hayato Nagase, Norihisa Kimura, Keinosuke Ishido, Hiroshi Kijima, Kenichi Hakamada","doi":"10.1111/ans.71009","DOIUrl":"https://doi.org/10.1111/ans.71009","url":null,"abstract":"<p><strong>Background: </strong>The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for distal cholangiocarcinoma (dCCA) uses depth of invasion (DOI) for T classification; however, it does not consider invasion into adjacent organs such as the pancreas. We investigated the prognostic significance of DOI and pancreatic invasion in patients with dCCA.</p><p><strong>Methods: </strong>We retrospectively analyzed 130 patients with dCCA who underwent pancreatoduodenectomy between 2003 and 2016. The optimal DOI cutoff for predicting overall survival (OS) was determined using time-dependent receiver operating characteristic analysis. Associations between clinicopathological factors, pancreatic invasion, and prognosis were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models.</p><p><strong>Results: </strong>The optimal DOI cutoff for OS was 4 mm. Patients with DOI > 4 mm had significantly poorer survival than those with DOI ≤ 4 mm (p < 0.0001). Pancreatic invasion was associated with worse prognosis (p < 0.001) and was more prevalent in tumors with greater DOI. Among patients with DOI > 4 mm, pancreatic invasion significantly worsened OS (p < 0.05), whereas no prognostic impact was observed in patients with DOI ≤ 4 mm. Multivariate analysis identified the combination of DOI > 4 mm and pancreatic invasion, lymph node metastasis, histological type, and positive resection margin as independent adverse prognostic factors. A novel classification incorporating DOI, pancreatic invasion, and lymph node status provided improved prognostic stratification.</p><p><strong>Conclusion: </strong>The combination of DOI > 4 mm and pancreatic invasion is an independent predictor of poor prognosis in dCCA. Incorporating pancreatic invasion into DOI-based classification may improve prognostic assessment beyond the current AJCC staging system.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206438","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":"Regional Lymph Node Management Following Neoadjuvant Immunotherapy in Stage III Cutaneous Melanoma.","authors":"Natalie Quarmby, Rebecca L Read","doi":"10.1111/ans.71012","DOIUrl":"https://doi.org/10.1111/ans.71012","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206447","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":"Retroperitoneal Sarcoma-Be Suspicious and Refer Early.","authors":"Mathew Hinksman, Hayden Snow","doi":"10.1111/ans.71014","DOIUrl":"https://doi.org/10.1111/ans.71014","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206495","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":"Investigating the Use of Routine Swabs in Incision and Drainage of Abscesses: An Audit of Western Sydney Hospitals.","authors":"Bethany Rachel O'Neill, Amy Hort, Lynne Mann","doi":"10.1111/ans.71003","DOIUrl":"https://doi.org/10.1111/ans.71003","url":null,"abstract":"<p><strong>Background: </strong>Incision and drainage of subcutaneous abscesses is a common surgical procedure. It is the standard of treatment, with or without adjunctive antibiotics. Interestingly, there exists a lack of evidence regarding the role of intraoperative sampling of the purulent discharge from abscesses. This study aimed to demonstrate whether intraoperative swab results were used to tailor antibiotic management and the circumstances surrounding these decisions. This will guide local practice for judicious collection of swabs and empirical antibiotic management. This is needed in the Western Sydney population, who are often co-morbid and experience recurrent abscesses.</p><p><strong>Methods: </strong>A retrospective cohort study was performed of Westmead and Auburn Hospital's incision and drainage surgeries of subcutaneous abscesses from 2023 to 2025.</p><p><strong>Results: </strong>A total of 2088 cases were identified and, in most cases (87%), an intraoperative swab was collected. The common causative organisms were staphylococcus, followed by streptococcus. Most organisms were pan-sensitive; however, of the multi-drug-resistant organisms, methicillin-resistant Staphylococcus aureus (MRSA) was most common. In 25% of cases where a causative organism was isolated, the bacteria were resistant to the antibiotic prescribed. However, the swab result only changed antibiotic management in 69 cases (3%). MRSA accounted for 62 of the 69 cases. Additionally, patients with causative organisms isolated were more often febrile (21%) than those without such swab results (16%) (p < 0.01).</p><p><strong>Conclusion: </strong>Overall, intraoperative swabs are recommended to be performed only in specific cases, not routinely. This includes patients who are febrile and patients with a history of or risk factors for multi-drug-resistant organisms such as MRSA.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179159","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":"Conservative Versus Operative Management of Small Bowel Obstruction in Pregnancy: An Updated Review of the Current Literature.","authors":"Nesta Emily Baxter, Lucy Brewis, Anjana Kumar, Eric Albinyana-Siergert, Georgios Anastasi, Tom Arkle, Irshad Shaikh","doi":"10.1111/ans.71015","DOIUrl":"https://doi.org/10.1111/ans.71015","url":null,"abstract":"<p><strong>Background: </strong>Small bowel obstruction (SBO) in pregnancy is rare but associated with high maternal and foetal morbidity. The incidence of this is rising with increasing rates of stoma formation in women of reproductive age.</p><p><strong>Methods: </strong>A stratified systematic search of MEDLINE, EMBASE and PubMed was conducted for cases published between 01/01/2015 and 31/12/2023. Cases were evaluated following PRISMA guidelines. Management strategies (operative, successful conservative, failed conservative) and outcomes including mortality and preterm delivery were analysed. A case of novel stomal decompression is presented.</p><p><strong>Results: </strong>This study reports a case of successful conservative management in late pregnancy SBO alongside an updated review of the literature. A 27-year-old woman with recurrent SBO was successfully managed conservatively with stomal Foley catheter decompression, avoiding surgery. Our systematic review identified 44 cases: 32/44 (72.7%) managed operatively and 12/44 (27.3%) had an initial trial of conservative management, 8/44 (18.2%) successful and 4/44 (9.1%) failed. Adhesions were the primary aetiology (19/44, 43.2%). Preterm delivery was 0/8 (0%) in the successful conservative group compared to 17/32 (53.1%) in the operative group and 3/4 (75.0%) in the failed conservative group. Overall maternal mortality was 3/44 (6.8%) and foetal mortality 5/44 (11.4%). MRI utilisation increased to 17/44 (38.6%) cases.</p><p><strong>Conclusion: </strong>A trial of conservative management appeared feasible in carefully selected, stable patients and was associated with fewer preterm deliveries. Early MRI, multidisciplinary care and minimally invasive decompression techniques may help optimise outcomes.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179202","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":"Predictors of Cranioplasty Failure: A Retrospective Cohort Study of 302 Patients.","authors":"I Gonzalez Matheus, M Redmond, S Olson, M Wagels","doi":"10.1111/ans.71006","DOIUrl":"https://doi.org/10.1111/ans.71006","url":null,"abstract":"<p><strong>Background: </strong>Cranioplasty is a frequently performed neurosurgical procedure, yet long-term durability remains variable and the factors predicting success or failure are not well established.</p><p><strong>Methods: </strong>We conducted a review of 302 adult patients who underwent cranioplasty at two tertiary centres between 2014 and 2021. Cranioplasty failure was defined as implant removal due to infection, structural failure or autologous bone resorption. Univariate and multivariate logistic regression analyses were performed to assess associations between failure and clinical variables including cranioplasty material, indication for initial craniectomy, defect site and size and having a prior cranioplasty.</p><p><strong>Results: </strong>The overall cranioplasty failure rate was 11.3%. Autologous bone was used in the majority of reconstructions (66.5%), with the remainder utilising alloplastic materials. Infection rates did not differ significantly between autologous and alloplastic reconstructions. Univariate analysis showed higher failure rates following trauma-related craniectomies. Multivariate regression demonstrated that trauma-related indications were independently associated with increased failure risk (OR 3.06, p = 0.003), while other factors including material type, defect site and prior cranioplasty were not statistically significant. In a separate model, large defects were not significantly associated with failure (OR 0.72, p = 0.50).</p><p><strong>Conclusion: </strong>Cranioplasty failure remains a multifactorial complication. Trauma-related indication was independently associated with increased failure risk, while material type, defect site and prior cranioplasty were not significant predictors. These findings highlight the need for prospective studies and longer-term surveillance, particularly in patients undergoing reconstruction following traumatic brain injury.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179205","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":"25, 50 and 75 Years Ago.","authors":"Julian A Smith","doi":"10.1111/ans.71000","DOIUrl":"https://doi.org/10.1111/ans.71000","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179149","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}