ANZ Journal of Surgery最新文献

{"title":"Benign Symptomatic Thyroid Nodules-A Place for a Randomised Trial of Sham Procedure Versus Radiofrequency Ablation?","authors":"Adam Morton","doi":"10.1111/ans.70206","DOIUrl":"https://doi.org/10.1111/ans.70206","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186350","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 Impact of Obesity on Intraoperative Complications in Rectal Cancer.","authors":"Simon Xu, Rathin Gosavi, Yigeng Li, James Lim, T C Nguyen, William Teoh, Geraldine Ooi, Vignesh Narasimhan","doi":"10.1111/ans.70190","DOIUrl":"https://doi.org/10.1111/ans.70190","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a growing global health concern and poses significant challenges in rectal cancer surgery. Excess visceral fat can obscure surgical landmarks, complicate dissection, and increase the risk of intraoperative adverse events (iAEs). Despite these recognized difficulties, there is limited objective data quantifying the impact of obesity on intraoperative complications. This study utilizes the CLASSIntra classification system to assess the incidence and severity of iAEs in patients with obesity (BMI ≥ 30 kg/m²) undergoing rectal cancer resection.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed patients undergoing rectal cancer resection between January 2014 and December 2023. Patients were stratified into groups by BMI (obese (BMI≥ 30 kg/m²) versus non-obese (BMI < 30 kg/m²)). The primary outcome was the incidence and severity of iAEs, graded using the CLASSIntra system. Secondary outcomes included conversion to open surgery, postoperative complications, ICU admissions, and overall length of stay.</p><p><strong>Results: </strong>There were 350 patients included (112 obese, 238 non-obese). There were significantly more iAEs in the obese group (40% vs. 26%, p = 0.010). Obesity was an independent predictor of intraoperative complications (OR 1.92, p = 0.010). Conversion to open surgery (27% vs. 40%, OR 2.30, p = 0.0100) and ICU readmission (50% vs. 31%, OR 2.35, p = 0.003) were significantly more common in patients with obesity. There were no significant differences in postoperative complication rates and hospital length of stay between groups.</p><p><strong>Conclusion: </strong>Obesity leads to a higher risk of intraoperative complications in rectal cancer surgery, increased conversion rates, and greater ICU resource utilisation. These findings highlight the technical challenges of rectal surgery in obese patients and emphasize the need for tailored preoperative planning, prehabilitation, and intraoperative strategies. Despite these intraoperative difficulties, structured postoperative care appears to mitigate differences in postoperative outcomes. Further research should explore preoperative interventions, such as weight optimization programs, to improve surgical outcomes in this high-risk population.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186355","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 Impact of Metachronous Colorectal Neoplasia Requiring Surgery After Cessation of Colonoscopic Surveillance at Age 75.","authors":"Ammar Manasawala, John Woodfield, Kari Clifford, Mark Thompson Fawcett","doi":"10.1111/ans.70199","DOIUrl":"https://doi.org/10.1111/ans.70199","url":null,"abstract":"<p><strong>Background: </strong>To assess the clinical and financial impact of metachronous colorectal neoplasia (MCRN) requiring surgery after cessation of colonoscopic surveillance at age 75.</p><p><strong>Methods: </strong>The Otago Clinical Audit database was interrogated to identify all colorectal neoplasia (CRN) resections between January 2020 and November 2022 and additional patients undergoing surgery for MCRN aged ≥ 75 (MCRN ≥ 75) between 2010 and 2020. The morbidity, hospital stay, and costs of surgery for MCRN ≥ 75 cases were compared to first colorectal neoplasia (FCRN) cases ≥ 75 and to all other colorectal resections, with and without propensity matching.</p><p><strong>Results: </strong>MCRN was identified in 3.1% of patients < 75 and 13.1% of patients ≥ 75. Identifying a further 41 patients with surgery for MCRN ≥ 75 after 2010 resulted in 55 patients with MCRN aged ≥ 75, 93 with FCRN aged ≥ 75, and 130 with CRN aged < 75. The median(IQR) age for MCRN ≥ 75 was 81 (78-86). Surgery for MCRN ≥ 75 compared to FCRN ≥ 75 resulted in complication rates of 70.9% and 50.5% (p = 0.024), hospital stay nine versus seven days (p = 0.012), readmissions 20% versus 6.5% (p = 0.026) and cost of NZD 31 021 versus 24 157 (p = 0.028). When compared to all other resections, and adjusting for different approaches to rectal cancer in elderly patients, these differences all increased. The estimated annual hospital cost for MCRN ≥ 75 surgery was NZD 317 777.</p><p><strong>Conclusion: </strong>MCRN accounted for 13.1% of operations in patients aged ≥ 75. This resulted in more morbidity and cost than surgery for FCRN ≥ 75. Stopping surveillance of those with previous surgery for CRN at 75 years of age results in significant institutional cost and patient morbidity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186354","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":"Acute Type-A Aortic Dissection in Hunter New England-A 10-Year Regional Australian Experience.","authors":"Ayesh Rathnayake, Apoorva Saboo, Olivia Chang, Takuya Narita, Rosauro Mejia","doi":"10.1111/ans.70181","DOIUrl":"https://doi.org/10.1111/ans.70181","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissection (AD) is a surgical emergency with significant mortality without prompt diagnosis and operative intervention. The management is time critical, and regional Australia represents an area of interest owing to its large distances and often paucity of resources. No previous studies examining Type-A AD in regional Australia have been done. The aim of this study is to describe acute Type-A AD within a regional population of Australia. The primary outcomes were incidence and mortality. The secondary outcomes were assessment of risk factors, challenges in diagnosis, and associated complications.</p><p><strong>Methods: </strong>A retrospective analysis was undertaken in the Hunter New England (HNE) health district of New South Wales (NSW) from 2010 to 2020. A total of 122 patients with an ICD-10 diagnosis of Type-A AD were included in the study. The data was analysed using the statistical package for the social sciences (SPSS). Odds ratio and 95% confidence interval (CI) were reported, and statistical significance was assumed at p < 0.05.</p><p><strong>Results: </strong>The incidence of Type-A AD in the HNE was 1.27 per 100 000 and overall mortality was 14.5%. Five percent of patients identified as Aboriginal and Torres Strait Islander. Combined risk factors of smoking and hypertension, postoperative CVA, and misdiagnosis demonstrated higher mortality which was statistically significant (p < 0.05).</p><p><strong>Conclusion: </strong>This study is the first study to illustrate Type-A AD in regional Australia. The findings reported here present a solid foundation for future studies to better understand the challenges faced in the diagnosis and management of AD.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186349","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 Growing Role of Artificial Intelligence in Surgical Education: ChatGPT Undertakes the Australian Generic Surgical Sciences Examination.","authors":"Allen Ao Guo, Ashan Canagasingham, Krishan Rasiah, Venu Chalasani, Julie Mundy, Amanda Chung","doi":"10.1111/ans.70186","DOIUrl":"https://doi.org/10.1111/ans.70186","url":null,"abstract":"<p><strong>Background: </strong>Large language models have undergone vast development in recent years. The advent of large language models such as ChatGPT may play an important role in enhancing future medical education.</p><p><strong>Methods: </strong>To evaluate the accuracy and performance of ChatGPT in the Generic Surgical Sciences Examination, we constructed a sample examination used to assess ChatGPT. Questions were sourced from a past questions bank and formatted to mirror the structure and layout of the examination. The performance of ChatGPT was assessed based on a predefined answer key recorded earlier.</p><p><strong>Results: </strong>ChatGPT scored a total of 468 marks out of a maximum total of 644 marks, scoring a final percentage of 72.7% across all sections tested. ChatGPT performed best in the physiology section, scoring 77.9%, followed by pathology, scoring 75.0%, and scored lowest in the anatomy section with 66.3%. When scoring was analyzed by question type, it was identified that ChatGPT performed best in the type \"A\" questions (multiple choice), scoring a total of 75%, which was followed closely by its performance in type \"X\" questions (true or false), where ChatGPT scored 73.2%. However, ChatGPT only scored 43.8% when answering type \"B\" questions (establishing a relationship between two statements).</p><p><strong>Conclusion: </strong>Our results demonstrate that ChatGPT completed the Generic Surgical Sciences Examination with accuracy exceeding the required threshold for a pass in this examination. However, the large language model struggled with certain question types and sections. Overall, further research regarding the utility of ChatGPT in surgical education is required, and caution should be exercised with its use, as it remains in its infancy stages.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186353","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":"Brachial Plexus Functional Outcomes After Thoracic Outlet Surgery as Measured by the Validated Brachial Assessment Tool.","authors":"Scott Ferris, Bridget Hill, Yi Xie","doi":"10.1111/ans.70202","DOIUrl":"https://doi.org/10.1111/ans.70202","url":null,"abstract":"<p><strong>Background: </strong>Thoracic outlet syndrome (TOS) is a condition of neurovascular compression in the cervicoaxillary canal and is commonly divided into neurogenic, venous, and arterial subtypes. Neurogenic TOS, caused by brachial plexus compression, is the most frequent subtype. Diagnosis and management remain challenging. Once diagnosed, conservative treatments are first-line, with surgical decompression reserved for refractory cases. Few validated patient-reported outcomes measures exist specifically for TOS.</p><p><strong>Methods: </strong>We conducted a prospective case series of 56 surgical decompressions of the thoracic outlet in 46 adults for neurogenic TOS. Patients completed the Brachial Assessment Tool (BrAT) and QuickDASH questionnaires preoperatively and on two separate follow-up appointments postoperatively. Changes in scores were statistically analyzed.</p><p><strong>Results: </strong>The brachial plexus specific BrAT scores showed significant serial improvements over 12 months following surgery (median BrAT change 18.0 then 31.0; p < 0.05). The familiar but more general QuickDASH scores serial change was -22.73 then -35.23. Strong negative correlations were found between BrAT and QuickDASH score changes (Spearman's rho -0.57 to -0.80; p < 0.05), recognizing that the two measure different constructs.</p><p><strong>Conclusion: </strong>This study demonstrates the responsiveness and clinical utility of the BrAT for quantifying impairment in TOS. This enables clinicians to establish the severity of the condition in individual patients, as well as assess the impact of interventions by subsequent utilization of the same measure. We propose and recommend the BrAT as an important tool to evaluate brachial plexus specific impairment in the assessment and management of neurogenic thoracic outlet syndrome.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186351","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":"Factors Contributing to the Incomplete and Close Margin Excision of Head and Neck Basal Cell Carcinoma (BCC).","authors":"Thomas Whitton, James O'Brien, Timothy Studley, Ho Yin Kam, Bruna Ragaini, Siddharth Karanth","doi":"10.1111/ans.70197","DOIUrl":"https://doi.org/10.1111/ans.70197","url":null,"abstract":"<p><strong>Introduction: </strong>Basal cell carcinoma (BCC) is the most common malignancy worldwide, occurring frequently on sun-exposed areas including the head and neck, where it is associated with relatively greater morbidity and complexity in treatment. The mainstay of treatment is surgical excision. Local recurrence has been shown to be reduced following excision with adequate microscopic margins; however, up to 25% of all excisions result in close or involved margins. This places great stress on the health system. The risk factors for incomplete excision are not yet fully understood. Our study aims to identify risk factors that contribute to incomplete or close margins in head and neck BCCs in an Australian tertiary Plastic and Reconstructive surgery unit.</p><p><strong>Method: </strong>A retrospective cohort study of patients undergoing excision of BCC in the head and neck region was undertaken between 2016 and 2020 at the Department of Plastic and Reconstructive Surgery at the Royal Hobart Hospital, Australia.</p><p><strong>Results: </strong>Increased rates of incomplete excision were observed with aggressive subtypes of BCC-infiltrating (OR = 2.91, p = 0.001), micronodular (OR = 4.07, p = 0.001), basosquamous (OR = 14.74, p < 0.001) and sclerosing (OR = 3.65, p < 0.001) and those on the ear (OR = 3.00, p = 0.0001). The presence of perineural invasion is also strongly associated with increased rates of incomplete and close margins (OR = 7.67, p ≤ 0.001). Larger lesion diameter (p < 0.001) and depth of invasion (p < 0.001) were strongly associated with incomplete excision.</p><p><strong>Conclusion: </strong>There is increased risk of incomplete excision of BCCs with aggressive subtype, location on the ear, and greater lesion diameter and depth of invasion. Careful screening of patients with these high-risk factors may help reduce incomplete or close margin excisions.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186352","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":"Endovascular Management of a Ruptured Aortoiliac Aneurysm With Iliocaval Fistula.","authors":"Luca Borruso, Peregrine Narborough, Tin Yau Ngan, Tim Shiraev","doi":"10.1111/ans.70205","DOIUrl":"https://doi.org/10.1111/ans.70205","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148914","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":"W(h)ither Carotid Interventions?","authors":"A Ross Naylor","doi":"10.1111/ans.70188","DOIUrl":"https://doi.org/10.1111/ans.70188","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148999","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":"Prognostic Value of Preoperative Inflammatory and Nutritional Markers in Lung Cancer.","authors":"Alexandra E Adams, Faisal A Shaikh, Zoltan H Nemeth","doi":"10.1111/ans.70203","DOIUrl":"https://doi.org/10.1111/ans.70203","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148977","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}