ANZ Journal of Surgery最新文献

{"title":"\"We Don't Want You to Be Dismissed\": Perspectives of Remediation From Surgical Education and Training Managers.","authors":"Kathryn McLeod, Robyn Woodward-Kron, Prem Rashid, Debra Nestel","doi":"10.1111/ans.70294","DOIUrl":"https://doi.org/10.1111/ans.70294","url":null,"abstract":"<p><strong>Background: </strong>While education and training managers are key personnel within surgical training programs regarding management of trainee performance including remediation, there is a lack of research concerning their perspectives. For improvements in remediation at a systems level, insight to their perspectives and experiences is essential.</p><p><strong>Methods: </strong>This qualitative study explored the perspectives of 12 education and training managers of surgical societies/associations/colleges in Australia and Aotearoa New Zealand. Purposive and snowball sampling was utilized for data collection in semi-structured interviews. Following an interpretivist approach, transcribed interviews were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes and 10 subthemes were identified: \"a guiding role\"; remediation is a \"well-oiled machine\"; remediation is \"not punitive\"; and room for improvement.</p><p><strong>Conclusion: </strong>Educational managers hold a pivotal role in guiding trainees and supervisors throughout the remediation process. From their perspective, remediation is considered well managed, with nearly all trainees successfully completing remediation. Although they recommend further resources and additional support for supervisors, their focus on improvement centers on tightening governance and reducing the risk of trainee litigation. Including the perspectives of managers in the remediation process will aid in its successful implementation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999559","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":"Survival Analysis of Postoperative Adjuvant Chemotherapy for Stage IB Non-Small Cell Lung Cancer Based on Racial Stratification.","authors":"Shaowei Xin, Tao Wang, Xiaodi Qi, Lei Hou, Yong Han, Changqi Ye","doi":"10.1111/ans.70317","DOIUrl":"https://doi.org/10.1111/ans.70317","url":null,"abstract":"<p><strong>Background: </strong>The survival benefits of adjuvant chemotherapy for stage IB non-small cell lung cancer (NSCLC) remain controversial. The existing evidence is mostly based on the Caucasian population, especially the differences in efficacy among different races are not yet clear.</p><p><strong>Method: </strong>Based on the data of patients with stage T2N0M0 NSCLC in the SEER database from 2010 to 2018 (n = 7458), they were divided into white people (6076 cases) and non-white people (1382 cases). The baseline characteristics of the adjuvant chemotherapy group and the non-adjuvant chemotherapy group were balanced by propensity score matching (PSM). The overall survival (OS) was assessed using Kaplan-Meier methodology with log-rank testing, while multivariable Cox regression analysis was employed to identify independent prognostic factors.</p><p><strong>Result: </strong>Among white people, the OS of the adjuvant chemotherapy group was significantly better than that of the observation group (p < 0.001 before and after PSM), and the benefits were consistent regardless of tumor diameter (≤ 4 or > 4 cm), VPI, or grade of differentiation. There was no statistically significant difference in OS among non-white people (p > 0.05 before and after PSM), and only the poorly differentiated subgroup showed limited benefits (p = 0.008). Multivariate Cox analysis confirmed that adjuvant chemotherapy was an independent predictor of OS in white people (p < 0.001), but not associated with non-white people (p = 0.184).</p><p><strong>Conclusion: </strong>There are significant racial differences in the efficacy of adjuvant chemotherapy for stage IB NSCLC, suggesting that treatment decisions need to be optimized in combination with racial background.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991432","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":"Functional Outcomes and Quality of Life in Patients Managed With Organ Preservation Following Total Neoadjuvant Therapy for Rectal Cancer-A Historical Cohort Study.","authors":"Thuy-My Nguyen, Luke Traeger, Tracy Fitzsimmons, Michelle Thomas, Tarik Sammour","doi":"10.1111/ans.70309","DOIUrl":"https://doi.org/10.1111/ans.70309","url":null,"abstract":"<p><strong>Aim: </strong>Total neoadjuvant therapy (TNT) for locally advanced rectal cancer improves oncological outcomes and organ preservation rates, but the impact on patient quality of life (QoL) is not known. This cohort study compares the quality of life (QoL) of post-TNT watch-and-wait (W&W) patients to a historical cohort of patients that underwent standard care.</p><p><strong>Method: </strong>Patients managed with a W&W approach following a personalised TNT (pTNT W&W group) were compared with historical group patients who had undergone standard treatment but who would have been eligible for pTNT under our current protocol (STD group). Patients were sent three questionnaires to complete: Survey of International Delphi consensus definition for lower anterior resection syndrome (LARS) symptoms, EORTC-QLQ-CR29, and the LARS score.</p><p><strong>Results: </strong>Questionnaires were completed for 29 of 41 patients in the pTNT W&W group, and 33 of 63 patients in the STD group (a response rate of 70.7% and 52.4%, respectively). Patients were well matched at baseline. The pTNT W&W group had significantly lower LARS rates (55.6% vs. 87.5%, p = 0.012) with fewer cases of major LARS (29.6% vs. 58.3%, p = 0.039). The pTNT W&W also had significantly improved QoL scores across several parameters of EORTC-QLQ-CR29 including stool frequency (20.7 vs. 30.8, p = 0.009), embarrassment regarding bowel symptoms (16.1 vs. 31.3, p = 0.018), and abdominal pain (5.8 vs. 14.1, p = 0.005).</p><p><strong>Conclusions: </strong>Despite retaining the irradiated rectum, patients managed with organ preservation after TNT experience a higher QoL with much lower, but not absent, rates of bowel and bladder dysfunction.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940116","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 Lifetime Risk of Incisional Hernia Following Open Abdominal Aortic Aneurysm Repair: A Longitudinal Cohort Study.","authors":"Maximilian Joret, Kelly Feng, Cameron Wells, Aleisha Easton, Carl Muthu, Anastasia Dean","doi":"10.1111/ans.70315","DOIUrl":"https://doi.org/10.1111/ans.70315","url":null,"abstract":"<p><strong>Background: </strong>Incisional hernia (IH) is a known complication of open abdominal aortic aneurysm repair (OAAAR), with reported rates ranging from 5.6% to 69%. Few studies have examined the long-term risk of IH. As OAAAR is often performed in younger patients requiring durable outcomes, understanding lifetime IH risk is important for preoperative counselling. This study aimed to determine the lifetime risk of IH following OAAAR.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent OAAAR at Auckland City Hospital between January 2004 and December 2008 was conducted. Patients who died within 30 days of surgery, who resided outside New Zealand, or who had incomplete medical records were excluded. Multivariable Cox regression analysis was performed to assess the influence of demographic, anthropometric, disease, and treatment factors on IH development.</p><p><strong>Results: </strong>Two hundred and twenty-six patients were identified, of whom 75.7% were male and 85.0% of European ethnicity. 90.7% of the cohort were deceased at the time of analysis. The median follow-up amongst survivors was 18.2 years. In total, 19% of patients developed an incisional hernia after OAAAR. IH was significantly more likely in patients with BMI ≥ 30 kg/m² (aHR 3.49, 95% CI 1.82-6.69, p < 0.001), and those with a previous midline laparotomy (aHR 2.52, 95% CI 1.09-5.85, p = 0.03).</p><p><strong>Conclusion: </strong>The rate of IH in our OAAAR patient cohort is lower than that described in other OAAAR patient cohorts with shorter follow-up, but is comparable to general laparotomy cohorts. These findings may assist pre-operative counselling on the long-term risk of IH after OAAAR.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940170","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":"Drivers of Research Productivity in Australian Surgical Departments: A Cross-Sectional Multivariable Analysis of a Single Tertiary Centre.","authors":"Christian Ratnayake, Mukund Karthik, Leonard Lee, Sascha Karunaratne, Kate Alexander, Michael Solomon, Sophie Hogan, Daniel Steffens","doi":"10.1111/ans.70314","DOIUrl":"https://doi.org/10.1111/ans.70314","url":null,"abstract":"<p><strong>Background: </strong>Research productivity is a key indicator of academic and clinical advancement in surgery. While previous studies have identified key drivers of productivity, comprehensive analyses examining the key determinants of research output across multiple Australian surgical departments remain limited.</p><p><strong>Methods: </strong>A cross-sectional study was conducted analysing publicly available data from 16 surgical departments at Royal Prince Alfred (RPA) Hospital in December 2024. Data on researcher characteristics, including number of publications, citations, h-index, higher degree by research (HDR) training, academic appointments, and international collaboration, were collated and aggregated for each department. Departmental research productivity was assessed through three primary outcomes: total publication count, aggregate citation count, and median h-index. Univariate and multivariable logistic regression analyses were performed in RStudio to examine associations between these factors and departmental research productivity, measured by publication count, citation count, and median h-index.</p><p><strong>Results: </strong>A total of 216 research members (148 consultants) were included. For publication count, univariate analyses showed significant associations with HDR training (p = 0.016) and academic appointment level (p = 0.048). In the multivariable model, only HDR training remained independently associated with publication count (β = 8.31, 95% CI: 1.77-14.85, p = 0.016, R² = 0.347). For h-index, HDR training (p = 0.027), academic appointment level (p = 0.138), international qualification (p = 0.039), and international collaboration (p = 0.044) showed associations in univariate testing. In the multivariable model, both HDR training (β = 0.29, 95% CI: 0.03-0.55, p = 0.030, R² = 0.491) and international collaboration (β = 0.47, 95% CI: 0.00-0.93, p = 0.048, R² = 0.491) remained significant. No multivariable models constructed for citations met statistical significance.</p><p><strong>Conclusions: </strong>This study highlights HDR training as the most consistent predictor of surgical research productivity across multiple metrics across surgical departments in a tertiary Australian hospital. International collaboration emerges as an additional significant driver of research impact, as measured by h-index. These findings provide evidence to support institutional investments in HDR training pathways and international collaborative networks as strategic approaches to enhance research culture and productivity in Australian surgical departments.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940165","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":"Very Early Recurrence Following Liver Resection for Intrahepatic Cholangiocarcinoma: Is It Predictable by Clinical Preoperative Factors?","authors":"Francesco Ardito, Francesco Razionale, Andrea Campisi, Çınar Turgay, Alessandro Coppola, Simone Vani, Maria Vellone, Felice Giuliante","doi":"10.1111/ans.70311","DOIUrl":"https://doi.org/10.1111/ans.70311","url":null,"abstract":"<p><strong>Background: </strong>Approximately one-quarter of patients undergoing resection for intrahepatic cholangiocarcinoma (ICC) experience very early recurrence (within 6 months after liver resection), which is associated with a poor prognosis. Identifying factors associated with very early recurrence may help optimize patient selection for surgery and avoid futile, high-risk hepatectomies. The aim of this study was to assess whether preoperative clinical factors alone can reliably predict very early recurrence following curative liver resection for ICC.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 83 patients who underwent liver resection between 2010 and 2020.</p><p><strong>Results: </strong>The 5-year overall survival (OS) rate for the entire cohort was 51.4%. Recurrence occurred in 54 patients (65.1%), with 17 (20.5%) experiencing very early recurrence. The 5-year OS for patients with very early recurrence was significantly lower than for those without it (0% vs. 48.7%, respectively; p = 0.013). Preoperative clinical prognostic factors failed to identify patients at high risk of very early recurrence, which occurred in 21% of patients classified as low risk.</p><p><strong>Conclusions: </strong>Preoperative clinical factors alone are insufficient for accurate risk stratification. Integrating clinicopathological data with molecular classifications of ICC is urgently needed to enable a more personalized oncological approach for these patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940097","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":"Contemporary Surgical Management of Colorectal Cancer in Lynch Syndrome: Considering the Implications of Known Genotype.","authors":"Ashley Jenkin, Kim-Chi Phan-Thien","doi":"10.1111/ans.70287","DOIUrl":"https://doi.org/10.1111/ans.70287","url":null,"abstract":"<p><strong>Background: </strong>Lynch syndrome (LS) is an autosomal dominant disorder caused by germline mutations in mismatch repair (MMR) genes, accounting for 1%-3% of all colorectal cancer (CRC) diagnoses. It is associated with an elevated lifetime CRC risk of 30%-80% and predisposes individuals to various extra-colonic malignancies. Advances in genetic profiling have refined our understanding of LS, offering opportunities to tailor surgical and surveillance strategies.</p><p><strong>Summary: </strong>The surgical management of LS is shifting from a uniform, aggressive approach to more nuanced strategies guided by patient-specific factors, including age, tumor characteristics, and genetic variants. While extended resections reduce metachronous CRC risk, they may not significantly improve survival compared to segmental resections and can negatively affect quality of life. Enhanced surveillance and emerging therapies, such as chemoprophylaxis and immunotherapy, are further reshaping treatment paradigms.</p><p><strong>Key message: </strong>Surgical management of LS must remain patient-centered, integrating functional outcomes, genetic risk, and individual circumstances. Genetic-variant-specific recommendations, coupled with personalized surveillance strategies, are essential to optimizing care without compromising survival or quality of life.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940111","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":"Comparative Analysis of Robotic Versus Laparoscopic Approaches in Minimally Invasive Spleen and Splenic Vessel Preserving Distal Pancreatectomy.","authors":"Ting-Kai Liao, Wei-Hsun Lu, Ping-Jui Su, Chih-Jung Wang, Ying-Jui Chao, Yan-Shen Shan","doi":"10.1111/ans.70310","DOIUrl":"https://doi.org/10.1111/ans.70310","url":null,"abstract":"<p><strong>Background: </strong>The use of robotic surgery in minimally invasive spleen and splenic vessel preserving distal pancreatectomy, known as Kimura technique (MI-KT), is on the rise. This study aims to compare the surgical outcomes of robotic and laparoscopic approaches.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients who underwent MI-KT at the National Cheng Kung University Hospital, comparing outcomes such as spleen preservation rate, operation time, blood loss, complications, and length of hospital stay, using propensity score matching.</p><p><strong>Results: </strong>Among 136 patients (111 laparoscopic, 25 robotic), proficiency milestones differed significantly. Although no statistically significant differences were observed in postoperative outcomes between the robotic and laparoscopic groups post-matching, the robotic approach exhibited a shorter learning curve (p < 0.001). Tumor size (OR 1.5, p = 0.015) was identified crucial to completion of KT.</p><p><strong>Conclusions: </strong>This study suggests that while the robotic approach may be advantageous in terms of learning curve, postoperative outcomes such as spleen preservation rates and hospital length of stay are comparable between the two methods, emphasizing the need for further analysis of patient selection and surgical techniques.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940106","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":"Are UK and Australian Trained Urologists the Same?-Ahpra Thinks They Are.","authors":"Kathryn McLeod, Richard Grills","doi":"10.1111/ans.70313","DOIUrl":"https://doi.org/10.1111/ans.70313","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940149","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":"Defining Resectability in Retroperitoneal Sarcoma: The Difficulty in Standardising Judgement in Complex Surgical Oncology.","authors":"Emily Smartt, Kilian G M Brown, David J Coker","doi":"10.1111/ans.70312","DOIUrl":"https://doi.org/10.1111/ans.70312","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940134","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}