ANZ Journal of Surgery最新文献

{"title":"Advanced Lung Cancer Inflammation Index as a Prognostic Inflammation-Nutrition Marker in Appendiceal High-Grade Pseudomyxoma Peritonei: A 10-Year Single-Center Study.","authors":"Yun Gao, Ruiqing Ma, Zhenhai Feng, Siyi Yang, Guangyu An","doi":"10.1111/ans.70884","DOIUrl":"https://doi.org/10.1111/ans.70884","url":null,"abstract":"<p><strong>Background: </strong>Pseudomyxoma peritonei (PMP) prognosis remains heterogeneous. Systemic inflammation and nutrition are linked to cancer survival, but their role in PMP is unclear. We aimed to evaluate the prognostic impact of inflammation-nutrition status in appendiceal high-grade PMP and to develop and internally validate a perioperative prognostic model.</p><p><strong>Methods: </strong>We retrospectively included patients with pathologically confirmed appendiceal high-grade PMP who underwent cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) between January 2015 and December 2024. Baseline variables included demographics, body mass index (BMI), tumor markers (CEA, CA19-9, CA125), inflammation-nutrition indices (advanced lung cancer inflammation index [ALI], prognostic nutritional index [PNI], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-monocyte ratio [LMR], systemic inflammation score [SIS], systemic immune-inflammation index [SII]), prior surgical score (PSS), peritoneal cancer index (PCI), completeness of cytoreduction (CC), HIPEC, pathological subtype, and Ki-67. Overall survival (OS) was the primary endpoint. Prognostic factors were identified by univariable and multivariable Cox models, and a nomogram was developed and internally validated.</p><p><strong>Results: </strong>Among 223 patients (146 females, 65.5%), median age was 59 years, and median OS was 21 months. In the multivariable Cox regression model, independent risk factors for worse overall survival (OS) were high-grade with signet-ring cells (hazard ratio [HR] = 2.575, 95% CI 1.749-3.790; p < 0.001), elevated CA19-9 (HR = 2.189, 95% CI 1.501-3.192; p < 0.001), elevated CA125 (HR = 1.495, 95% CI 1.050-2.127; p = 0.026), high Ki-67 (HR = 1.976, 95% CI 1.238-3.154; p = 0.004), and an unfavorable CC (CC1-3) (HR = 2.705, 95% CI 1.295-5.648; p = 0.008), while receipt of hyperthermic intraperitoneal chemotherapy (HIPEC) (HR = 0.611, 95% CI 0.377-0.991; p = 0.046) and a high ALI (HR = 0.576, 95% CI 0.398-0.834; p = 0.003) were independent protective factors. The model achieved a C-index of 0.753, with 1-, 2-, and 3-year AUCs of 0.810, 0.839, and 0.775, respectively. Calibration error was low (≈3%-6%) and decision-curve analysis showed sustained net benefit across broad threshold ranges.</p><p><strong>Conclusions: </strong>The ALI is an independent prognostic marker in appendiceal high-grade PMP. A nomogram incorporating ALI with tumor and pathological variables enabled reliable perioperative survival prediction with strong discrimination, calibration, and clinical utility.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590181","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":"Temporal Trends in Intracavernosal Injection Therapy and Penile Prosthesis Implantation in the Era of Phosphodiesterase-5 Inhibitors for Erectile Dysfunction in Australia.","authors":"Nicholas Gillman, Eric Chung","doi":"10.1111/ans.70830","DOIUrl":"https://doi.org/10.1111/ans.70830","url":null,"abstract":"<p><strong>Introduction: </strong>Phosphodiesterase-5 inhibitors (PDE5-Is) transformed erectile dysfunction (ED) management as first-line therapy; nonetheless, many patients require second- and third-line options due to inadequate response, side effects, or contraindications. This article evaluates temporal trends in intracavernosal injection (ICI) therapy and penile prosthesis implantation (PPI) in Australia since PDE5-Is introduction.</p><p><strong>Methods: </strong>MBS item numbers 37415 (ICI), and 37429/37426 (PPI) from 1998 to 2024 were analysed. Data were stratified by age and state, standardised to Australian male population estimates, and reported per 100 000 men. Compound annual growth rates (CAGR) were calculated with break points at major events (release of PDE5-Is, generics, COVID-19). RPBS data were extracted for eligible PDE5-Is and alprostadil from 1998 to 2024. Government expenditure was included and trends compared with international cohorts.</p><p><strong>Results: </strong>Across 260 756 procedures (17 882 PPI; 242 874 ICI), PPI sharply declined in 1996-1999 (CAGR -16.02%/year) after sildenafil introduction but demonstrated sustained growth over time (+7.08%/year 2000-2009 and +4.73%/year 2010-2020). Growth slowed to +1.94%/year 2020-2024 with COVID-related elective surgery disruptions. ICI use collapsed after 1998, stabilised in the 2010s, and contracted further during COVID, equating to a 97% reduction (CAGR -11.4%/year). PPI shifted toward older men aged 55-84 with marked increase in those aged 65-74 and 75-84 years, while ICI has transitioned to almost exclusive use in men over 55 years old. Government expenditure declined more than sixfold between 1996 and 2003 but plateaued since 2010 with PPI and ICI maintaining similar annual cost. From 1999 to 2024, RPBS-subsidised PDE5-Is prescriptions rose from ~440 to 25 500 yearly prescriptions, with early sildenafil predominance shifting to tadalafil, which accounts for 58% of use in 2024.</p><p><strong>Conclusion: </strong>There has been a considerable change in trends of invasive ED therapies over the past 30 years since the introduction of PDE5-Is. There has been a significant decline in ICI therapy over the study period, with a recent increased uptake in PPI utilisation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590195","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 Vanishing Pouch: Planned Centralisation of Ileal Pouch-Anal Anastomosis for Ulcerative Colitis in Australia-A Regional Consensus Perspective.","authors":"Naseem Bhorat, Daniel Cattanach, Michelle Chen, Juyong Cheong, Heng-Chin Chiam, Julie Flynn, Ricardo Hamilton, Howard Joy, Rob Knox, Michael Lamparelli, David Mackrill, Masselan Naidoo, Pieter Prinsloo, Boris Ruggiero, Nicholas Smith","doi":"10.1111/ans.70885","DOIUrl":"https://doi.org/10.1111/ans.70885","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583381","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":"Fallopian Tube Removal During Non-Gynaecological Intra-Abdominal Surgery: An Opportunity to Prevent High Grade Serous Tubo-Ovarian Cancer.","authors":"Alexandra Jolley, Rinkita Sinha, Jacob McCormick, Timothy J Chittleborough, Rosemary McBain, Orla M McNally","doi":"10.1111/ans.70880","DOIUrl":"https://doi.org/10.1111/ans.70880","url":null,"abstract":"<p><strong>Background: </strong>Opportunistic salpingectomy (OS) is increasingly recommended during gynaecological surgery for primary prevention of ovarian, tubal and peritoneal cancer. Emerging evidence supports its feasibility during abdominal surgery for non-gynaecological indications; however, uptake remains limited.</p><p><strong>Methods: </strong>ShiELD (Opportunistic Salpingectomy at the time of Elective Abdominal Surgery) was a pilot study conducted at a tertiary level institution involving non-gynaecological surgeons. Participants completed a Likert-scale assessment of knowledge, attitudes, perceived barriers and confidence regarding OS before and after an intervention, which was viewing a targeted educational video. Responses were analysed descriptively, with Likert categories collapsed into agreement versus non-agreement.</p><p><strong>Results: </strong>Forty surgeons completed the survey. Baseline understanding of OS was high (76.9%), but knowledge of complications (38.4%), surgical technique (33.4%) and patient selection (28.2%) was limited. Only 20.5% felt comfortable performing OS independently. Following the intervention, agreement improved across all domains, including understanding of OS (100%), complications (80.0%), surgical technique (89.8%) and patient selection (72.5%). Comfort performing OS independently increased to 55.0%, while discomfort with consent decreased from 66.6% to 40.0%.</p><p><strong>Conclusion: </strong>A brief educational intervention significantly improved non-gynaecological surgeons' knowledge, confidence and willingness to consider opportunistic salpingectomy. Education represents a critical step toward broader implementation of OS in non-gynaecological surgical practice.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560587","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 Ileal Pouch Reconstruction Using a Modified 2-Stage Approach.","authors":"Hugh L Giddings, David A Clark","doi":"10.1111/ans.70875","DOIUrl":"https://doi.org/10.1111/ans.70875","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560627","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":"Increasing Rates of Anti-Reflux Procedures in Australia: Upcoding and Misuse of Medicare Item Numbers?","authors":"Sarah K Thompson, David I Watson","doi":"10.1111/ans.70881","DOIUrl":"https://doi.org/10.1111/ans.70881","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560541","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":"Horseshoe Polycystic Kidney Nephrectomy-A Rare Surgical Challenge.","authors":"Rohit Sethi, Dylan R Barnett, Ashvini Shekhar, Santosh Olakkengil, Shantanu Bhattacharjya","doi":"10.1111/ans.70817","DOIUrl":"https://doi.org/10.1111/ans.70817","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534933","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":"Anal Cancer Screening and High-Resolution Anoscopy: What Surgeons Should Know.","authors":"Matthew Joseph Marino, Benedict Blacket, Richard Clive Turner, Tamzin Cuming, David R C James","doi":"10.1111/ans.70873","DOIUrl":"https://doi.org/10.1111/ans.70873","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534943","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":"Preoperative Factors Associated With Early- to Medium-Term Patient-Reported Outcomes Following Volar Locking Plate Fixation of Distal Radius Fractures.","authors":"Martin Franke, Samuel Raymond, James Ledgard, Belinda Rouvray, Joanna Prior, Brahman Sivakumar","doi":"10.1111/ans.70868","DOIUrl":"https://doi.org/10.1111/ans.70868","url":null,"abstract":"<p><strong>Introduction: </strong>Distal radius fractures are common injuries with a substantial burden of disease. Although volar locking plate fixation is commonly used, the relationship between preoperative factors and early- to medium-term patient-reported outcomes remains poorly delineated. This study examined whether patient characteristics, injury features and routine prereduction radiographic measurements were associated with 3-month Patient-Rated Wrist and Hand Evaluation (PRWHE) scores after volar locking plate fixation.</p><p><strong>Methods: </strong>A retrospective cohort study at a tertiary trauma centre was conducted. Adults who underwent volar locking plate fixation were identified from a prospectively maintained registry. Demographics, comorbidities, injury details and prereduction radiographs were reviewed. The primary outcome was the PRWHE score at 3 months postoperative. Grip strength and range of motion were also assessed, where available. Multivariable linear regression analysis evaluated associations between preoperative factors and PRWHE scores. Sensitivity analysis utilised complete-case analysis, and paired testing was used to assess temporal associations.</p><p><strong>Results: </strong>Amongst prereduction radiographic factors, greater sagittal translation and ulnar styloid fracture were associated with poorer patient-reported outcomes. Older age was associated with worse function, and female sex was associated with better outcomes. When considering clinician-measured outcomes, greater grip strength and ulnar deviation were associated with superior patient-reported outcomes. Analysis of the small paired 3- to 6-month cohort revealed improvement in pain, grip strength and wrist range of motion.</p><p><strong>Conclusion: </strong>Certain prereduction radiographic features, male sex and older age are associated with poorer patient-reported outcomes following volar locking plate fixation of distal radius fractures. These findings may assist in preoperative counselling, prognostication and identification of patients at risk.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519926","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 Cost of Imperfection: Recurrence-Adjusted Costs of Sphincter-Preserving Procedures for Complex Anal Fistula in Australia.","authors":"Matthew P Irwin, Matthew J Morgan, Catherine E Turner, Kevin C Ooi, Yang Yu","doi":"10.1111/ans.70872","DOIUrl":"https://doi.org/10.1111/ans.70872","url":null,"abstract":"<p><strong>Background: </strong>Complex cryptoglandular anal fistula is frequently complicated by treatment failure, repeat intervention and ongoing healthcare use. Economic evaluations are limited, rarely incorporate failure-related re-intervention, and seldom distinguish between public and private settings. This study compared 12-month pathway costs for ligation of the inter-sphincteric fistula tract (LIFT), endorectal advancement flap (ERAF), video-assisted anal fistula treatment (VAAFT) and non-definitive seton management in Australia.</p><p><strong>Methods: </strong>A micro-costing analysis was performed using 2023-24 Australian public and private hospital data. Costs were calculated from the hospital perspective and incorporated procedures required after treatment failure over 12 months, reflecting pathway costs rather than index procedure costs. Failure rates and re-intervention pathways were derived from a prospectively maintained cohort treated within a single colorectal surgical network (LIFT n = 88; ERAF n = 16; VAAFT n = 22). Non-definitive seton management was modelled as one, two or four planned operative episodes per year.</p><p><strong>Results: </strong>Crude observed 12-month treatment failure was similar across definitive procedures (LIFT 36%, ERAF 38%, VAAFT 36%). Pathway costs incorporating treatment failure were AUD 1846/8858 for LIFT, AUD 2161/9164 for ERAF, and AUD 1937-2968/8870-10 499 for VAAFT in public/private hospitals, depending on case volume. Seton management cost AUD 871-3484/5050-20 200 per year, depending on operative frequency.</p><p><strong>Conclusion: </strong>Incorporating treatment failure narrowed cost differences between definitive sphincter-preserving techniques. Non-definitive seton costs were frequency-dependent. Local case volume, admission pathway, and failure burden should inform service planning and VAAFT adoption.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519905","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}