ANZ Journal of Surgery最新文献

{"title":"Clinical Outcomes of Patients Submitted to Pelvic Exenteration With Major Vascular Resection and Reconstruction: A Systematic Review of the Literature","authors":"Konstantinos Perivoliotis,&nbsp;Paris Tekkis,&nbsp;Anisha Sukha,&nbsp;Maximos Frountzas,&nbsp;Sheng Qiu,&nbsp;Christos Kontovounisios,&nbsp;Shahnawaz Rasheed","doi":"10.1111/ans.70785","DOIUrl":"10.1111/ans.70785","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The present study aims to evaluate the current data regarding the clinical outcomes of patients undergoing pelvic exenteration with major vascular resection and reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted according to the PRISMA guidelines and the Cochrane handbook. Scholar databases were systematically screened. The last search date was March 2026. The primary endpoint was the overall complications rate. Secondary endpoints included specific postoperative complications, oncological outcomes of interest, and perioperative efficacy metrics. Random Effects (RE) models were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 6 studies and 69 patients were included in this study. Pooled complications rate was 57.9% (95% CI: 32.2%–83.6%, <i>p</i> = 0.003). Overall vessel thrombosis and reoperation rates were estimated to be 16.5% (<i>p</i> = 0.008) and 21.7% (<i>p</i> = 0.011). The reported reoperated cases included hemostasis n:13, stent placement n:3, thrombectomy n:2, fasciotomies n:2 and amputation n:1. R0 resection margin was achieved in 58.2% (<i>p</i> = 0.002) of patients. It was shown that in cases with a primary tumor R0 rate was 50% (<i>p</i> = 0.295), while in the recurrent malignancies this dropped to 42% (<i>p</i> = 0.364). Two patients had local relapse at 15 and 25 months while distal metastasis related mortality developed in two patients at 14 and 22 months after surgery. In total, the pooled local recurrence rate was 20% (<i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We estimated a significant overall morbidity burden with increased risk for loss of vascular patency and reoperation and suboptimal oncological outcomes. Despite this, cases with pelvic confined disease that require vascular reconstruction can still be amendable in curative surgery following multidisciplinary assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2321-2330"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209650","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 Intriguing History of Gloves and Their Application to Surgery","authors":"Spencer W. Beasley","doi":"10.1111/ans.70834","DOIUrl":"10.1111/ans.70834","url":null,"abstract":"<p>Many millennia ago, gloves were devised for protection, first from the cold and then to protect the hands from injury. In time, they became associated with social class, wealth and as a sign of privilege. With status and prestige followed the glamour and commercialism of fashion. Surgeons had little interest in gloves until relatively recently unless they were dealing with foul and putrid wounds. The first serious use of gloves in surgery was to protect hands from the irritating effects of antiseptics such as mercuric chloride—until Joseph Bloodgood noticed that they also markedly reduced surgical infection rates. Soon glove-wearing became routine in surgery and the drive, promoted by glove manufacturers, moved to expansion of their use. An example of this is the increased use of double-gloving for elective soft tissue surgery. The obsession to reduce infection at all costs (based on theoretical grounds from observing glove micro-perforations after surgery) without any evidence of actual benefit to patient or surgeon (no RCT has shown reduction in SSIs or blood-borne transmission of infection from double-gloving) has led to actual harm, particularly if the environmental damage and huge costs to healthcare services are taken into account. Review of the history of surgical gloves suggests that some accepted dogma should be challenged and that guidelines for glove wearing would be better aligned to the available evidence if they are to minimize harm.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2278-2283"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70834","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403346","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":"Oncovascular Resection in Pelvic Exenteration: A Systematic Review","authors":"Joshua Richard Burke,&nbsp;Yasmin Oskui,&nbsp;Imogen Samuel,&nbsp;Jonathan Wild,&nbsp;Kilian G. Brown,&nbsp;Jonathan Ghosh,&nbsp;Paul A. Sutton","doi":"10.1111/ans.70824","DOIUrl":"10.1111/ans.70824","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Resection of major vascular structures may be required to achieve R0 resection in pelvic exenteration surgery for advanced pelvic malignancy. The evidence base for pelvic oncovascular techniques is limited, with patient outcomes following these procedures not widely reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This systematic review synthesises the current literature on R0 resection and 30-day mortality rates following oncovascular pelvic exenteration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted according to a pre-defined protocol (PROSPERO ID CRD42024613055). MEDLINE, EMBASE, Cochrane Library and Web of Science were interrogated between January 1, 1947, to July 1, 2025. Studies exploring oncovascular resection in advanced pelvic malignancy were considered. Pre-1980 studies were included narratively but excluded from quantitative synthesis. Data were extracted on R0 resection, postoperative morbidity and mortality. The ROBINS-1 V2 tool was used to assess bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies met the inclusion criteria. After excluding three pre-1980 studies, 411 contemporary patients were included in quantitative analysis. Among curative-intent procedures (<i>n</i> = 334), the R0 resection rate was 65.3% (218/334). With regards to morbidity, Clavien–Dindo grade I–II complications occurred in 56.9% (227/399) and grade III–IV complications in 28.5% (109/382). Thirty-day mortality was 1.9% (8/411). Median overall survival was 41 months (range 34–57.6), with median disease-free survival of 27 months (range 8–43.2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately two thirds of patients undergoing oncovascular pelvic exenteration achieved R0 resection, with morbidity and 30-day mortality of 1.9%. Outcomes remain inferior to contemporary benchmark series for conventional exenteration, reflecting the pioneering phase of oncovascular practice. Centralisation, rigorous audit and benchmarking and improved patient selection should be the focus of future work to improve R0 and complication rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2308-2320"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70824","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403361","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":"Waiting List Policy Reform Is Required to Enable Randomised Controlled Trials of Elective Surgery","authors":"Jonathan G. Quicke,&nbsp;Deborah J. Brown,&nbsp;Bernadette Richards,&nbsp;Owen Ung,&nbsp;Catherine McDougall,&nbsp;Sandra Crone,&nbsp;Nadine E. Foster","doi":"10.1111/ans.70744","DOIUrl":"10.1111/ans.70744","url":null,"abstract":"&lt;p&gt;Randomised controlled trials (RCTs) are the gold standard for evidencing the comparative clinical and cost effectiveness of elective surgery [&lt;span&gt;1, 2&lt;/span&gt;]. However, only around 1 in 5 surgical RCTs recruit to time and target [&lt;span&gt;3&lt;/span&gt;]. Potential solutions to better-enable surgical RCTs include ring-fenced research resources, allocated trial capacity, more streamlined governance processes and registry based RCTs [&lt;span&gt;4&lt;/span&gt;]. Here we address another key factor jeopardising successful RCT recruitment in Australia—the impact of waiting lists [&lt;span&gt;4&lt;/span&gt;], with the legacy system favouring adherence to waiting lists irrespective of RCTs. We challenge the prevailing assumption that it is unfair to prioritise participants in elective surgery trials over medically similar non-participating patients, arguing that this rests on an incomplete understanding of the nature of fairness.&lt;/p&gt;&lt;p&gt;Current regulation (both broad policy and guidelines) of elective surgical waiting lists and whom should be prioritised is silent on RCTs (Box 1). This leaves surgical services engaged in RCTs to either (1) treat RCT participants the same as non-participating patients, or (2) apply their own prioritisation criteria, potentially circumventing national/state/local directives. Both ‘solutions’ are ethically problematic and we advocate for a third option: developing policy that warrants prioritising RCT participants. We justify this proposal by contrasting 2 scenarios (Box 2) relating to a hypothetical RCT investigating the clinical and cost effectiveness of total knee replacement (TKR) compared to conservative care. National median waitlist time for elective TKR surgery, is 265 days in the public sector [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Our proposal raises an ethical dilemma requiring the balancing of different interests. Scenario 1 upholds the principle of justice through equal access to healthcare. However, if this is reconsidered by instead prioritising those enrolled in the RCT—Scenario 2—, then the broader public good is maximised through generation of best evidence.&lt;/p&gt;&lt;p&gt;In Scenario 1, waiting lists delay or prevent RCT recruitment (which is limited by finite funding and a fixed end date), lead to an underpowered RCT, increased chance of Type II error, and ongoing clinical uncertainty [&lt;span&gt;6&lt;/span&gt;]. This indirectly harms future patients, surgeons, healthcare systems, researchers and taxpayers who fund RCTs through government funding bodies like National Health Medical Research Council (NHMRC) and the Medical Research Future Fund (MRFF) scheme. All these interest holders may ultimately become disillusioned with the feasibility and value of surgical RCTs.&lt;/p&gt;&lt;p&gt;From a utilitarian perspective, Scenario 2 is well-justified. By removing long delays for elective surgery RCT participants, the trial has a higher chance of recruiting its target sample size and providing precise estimates of clinical effectiveness and cost-effectiveness. However, we are mindful ","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2252-2255"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70744","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300753","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":"After the Injury: The Long-Term Life Toll of Trauma in New Zealand","authors":"Rebecca J. Ryznar,&nbsp;Zsolt J. Balogh","doi":"10.1111/ans.70769","DOIUrl":"10.1111/ans.70769","url":null,"abstract":"&lt;p&gt;Modern trauma systems have substantially improved survival via improvements of prehospital and acute hospital care of the injured, yet post-discharge recovery remains comparatively underdeveloped as a central focus of care. Approximately 21% of traumatic injury survivors develop PTSD, 6% develop depression [&lt;span&gt;1&lt;/span&gt;], and 11% develop a new-onset mental health condition after injury, with the new diagnoses associated with more frequent hospitalization, suicide, and higher all-cause mortality risk [&lt;span&gt;2&lt;/span&gt;]. While age, injury severity, comorbidities, and prolonged hospitalization are well-recognized non-modifiable contributors to poor physical long-term recovery, multiple studies suggest that psychological and social outcomes are influenced by factors independent of injury severity. This indicates that determinants beyond anatomical injury shape long-term recovery trajectories [&lt;span&gt;3-5&lt;/span&gt;]. Trauma survivors must not only recover from the physical injury but heal while navigating pain, fear, work disruption, emotional burden, and the challenge of obtaining and maintaining medical and psychosocial support after discharge [&lt;span&gt;6&lt;/span&gt;]. A recent study conducted by Logan et al. shifts attention toward the post-discharge terrain of trauma recovery to determine whether patients have psychiatric difficulty and are appropriately supported after they leave the hospital.&lt;/p&gt;&lt;p&gt;The single-center retrospective cohort study from Christchurch, New Zealand [&lt;span&gt;7&lt;/span&gt;] examined post-trauma recovery among major trauma survivors identified through the New Zealand Major Trauma Registry. Participants completed patient-reported measures assessing PTSD, anxiety, depression, follow-up care experiences, Accident Compensation Corporation (ACC)-related challenges, and perceived social support. Overall, 14.9% of survivors reported problems accessing follow-up care, and 24.6% reported ACC-related challenges. Psychological symptoms were strongly associated with these reported difficulties where participants meeting the threshold for PTSD were more likely to report ACC-related problems than those below the threshold (65.2% vs. 16.2%) and were also more likely to report problems with follow-up care (45% vs. 11%). Similar patterns were observed for anxiety and depression, with all comparisons reaching statistical significance (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Lower perceived social support was also significantly associated with worse reported recovery experiences. In contrast, injury severity and ICU admission were not associated with these outcomes, suggesting that post-trauma recovery burden may be shaped more strongly by psychological and social factors than by anatomical injury severity alone.&lt;/p&gt;&lt;p&gt;The most compelling implication of this study is that the findings suggest trauma recovery is shaped not only by the physical injury, but also by the post-injury recovery environment. Patients described inadequate support services, barriers to follow-up assessme","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2245-2247"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136623","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":"Indocyanine Green Fluorescence Cholangiography in Minimally Invasive Cholecystectomy: Routine Practice or Selective Adjunct?","authors":"Rostyslav Nikolenko,&nbsp;Zi Qin Ng","doi":"10.1111/ans.70507","DOIUrl":"10.1111/ans.70507","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2264-2266"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017155","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":"Reconsidering Laparoscopic Peritoneal Lavage for Hinchey III Perforated Diverticulitis: A Staged Pathway Hypothesis for Selected High-Capability Centres","authors":"Ju Yong Cheong,&nbsp;Maseelan Naidoo,&nbsp;Heng Chin Chiam,&nbsp;Boris Ruggiero,&nbsp;Christian Beardsley,&nbsp;Esh Jeyarajan,&nbsp;Merwe Hartslief,&nbsp;Omar Mouline,&nbsp;Craig Moore,&nbsp;Tara Connelly,&nbsp;Jin Kim","doi":"10.1111/ans.70697","DOIUrl":"10.1111/ans.70697","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2274-2277"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760616","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":"Expanding the Practice of Day-Case Inguinal, Femoral and Umbilical Hernia Repair: A Review of Patient and Procedural Factors Facilitating and Precluding Same-Day Discharge","authors":"Minh T. Calder,&nbsp;Elise J. Ho,&nbsp;Simon K. Ho,&nbsp;Shiran Wijeratne","doi":"10.1111/ans.70667","DOIUrl":"10.1111/ans.70667","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the advantages of lower healthcare costs and decreased elective surgery wait times without compromise to patient outcome, rates of day-case hernia repairs remain much lower than the RACS target of 70%–80%. Certain patient cohorts are often unnecessarily excluded due to perceived risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To review literature on patient and procedural factors influencing same-day discharge after inguinal, femoral, and umbilical hernia repairs, and to outline an evidence-based selection criteria and perioperative protocol to improve day-case rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of peer-reviewed English-language studies involving inguinal, umbilical, and femoral hernia repairs in patients over 18 years, in day and overnight case settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patient factors facilitating same-day discharge are age under 65 years, ASA grades I–II, and uncomplicated hernia types. Selected patients aged over 65 or with ASA grades III–IV may be appropriate candidates and should not be excluded by default. Procedural factors facilitating same-day discharge include unilateral surgery, use of adjunctive local anaesthesia, and protocols to reduce risk of common postoperative complications. Logistical factors such as comprehensive discharge planning and strategic theatre scheduling can further increase the success of day-cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For appropriately selected patients, aged up to 80 years and ASA up to IV, day-case hernia repair can be a safe and effective alternative, offering comparable clinical outcomes and greater socioeconomic benefits. Comprehensive and holistic perioperative planning plays a crucial role to successfully expand day-case hernia repairs. Based on the results of this study, a patient selection criteria and perioperative protocol for day-case hernia repair are proposed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2300-2307"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626985","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":"Impact of Pre-Operative Nutritional Status on Postoperative Outcomes Following Pelvic Exenteration: A Systematic Review and Meta-Analysis","authors":"Lorcan Byrne,&nbsp;Cian Keogh,&nbsp;Craig Harris,&nbsp;Eamon Francis,&nbsp;Christina Buckley,&nbsp;Peter Lonergan,&nbsp;Louise McLoughlin,&nbsp;Feras Abu Saadeh,&nbsp;Michael Kelly,&nbsp;Ben Creavin","doi":"10.1111/ans.70896","DOIUrl":"10.1111/ans.70896","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pelvic exenteration is an extensive procedure for advanced or recurrent pelvic malignancies, associated with high morbidity and mortality. Malnutrition is common in this cohort and may affect postoperative outcomes, but the current evidence remains inconsistent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A systematic review was performed following PRISMA guidelines. Pooled analyses were used to assess the relationship between preoperative nutritional status (serum albumin, BMI, and Subjective Global Assessment (SGA)) and postoperative outcomes, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine retrospective cohorts comprising 1057 patients were included. The median age across studies was 56 years. Primary tumour types included colorectal, gynaecological, bladder, and soft tissue sarcoma. All studies reported complications, most of which were classified using the Clavien–Dindo system. Low BMI was linked to increased postoperative morbidity (OR 1.12, 95% CI 1.02–1.23, *<i>p</i> = 0.02). Hypoalbuminemia (&lt; 35 g/L) (OR 1.38, 95% CI 0.62–3.08, <i>p</i> = 0.44) and SGA-defined malnutrition (OR 1.24, 95% CI 0.24–6.48, <i>p</i> = 0.09) showed non-significant but consistent trends towards higher complications in malnourished patients. Secondary outcomes were statistically significant, with malnourished patients experiencing longer hospital stays (SMD 0.44, 95% CI 0.26–0.62, *<i>p</i> &lt; 0.00001) and more reoperations (OR 1.82, 95% CI 1.08–3.09, *<i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-operative malnutrition is linked to increased morbidity after pelvic exenteration. Low BMI was associated with increased postoperative morbidity following pelvic exenteration, while hypoalbuminaemia and SGA-defined malnutrition demonstrated consistent but non-significant associations. These findings support routine nutritional screening and preoperative optimisation in this high-risk patient group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2331-2338"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787597","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":"AI and Epigenetics: A New Opportunity for Early Pancreatic Cancer Detection in Australia","authors":"Jaswinder S. Samra,&nbsp;Krishna Kotecha,&nbsp;Anubhav Mittal","doi":"10.1111/ans.70852","DOIUrl":"10.1111/ans.70852","url":null,"abstract":"&lt;p&gt;Pancreatic ductal adenocarcinoma (PDAC) is now the third leading cause of cancer-related death in Australia and is poised to overtake colorectal cancer mortality globally [&lt;span&gt;1, 2&lt;/span&gt;]. Despite decades of clinical trials, five-year survival has stagnated at approximately 14% [&lt;span&gt;3&lt;/span&gt;]—a failure largely attributed to PDAC's typically late-stage presentation, early systemic spread, cold immunogenicity, and historically undruggable KRAS mutations [&lt;span&gt;4&lt;/span&gt;]. The primary risk factors for pancreatic cancer include tobacco use, chronic pancreatitis, and obesity, alongside non-modifiable factors such as older age, a family history of the disease, and inherited genetic syndromes. Despite recent advances in KRAS targeted therapies [&lt;span&gt;5&lt;/span&gt;], early diagnosis and surgical resection remain the only viable option of cure for PDAC. Of the five most common causes of cancer-related death in Australia, four have some form of screening and early detection available in Australia. Breast and colorectal cancer have mature screening programs; prostate cancer screening in the form of serum PSA (although controversial) is easily available, and low-dose chest CT in high-risk patients has become part of the National Lung Cancer Screening Program (NLCSP) as of July 2025. Currently, there is no established screening tool for PDAC in the asymptomatic population. The recently commenced Australian Pancreatic Cancer High-Risk Screening Program (APRISE) is a non-randomized trial of screening high-risk (with familial or genetic history) patients to undergo endoscopic ultrasound (EUS) and MRI imaging. While APRISE is a critical step forward, these investigation modalities are resource-intensive and require specialized gastroenterological and radiological expertise found primarily in metropolitan centers. Our proposed strategy seeks to augment this framework by providing a cost-effective, less invasive entry point that could eventually transition high-risk surveillance to the primary care setting.&lt;/p&gt;&lt;p&gt;The introduction of various artificial intelligence (AI) driven imaging assessments has potentially unearthed a cost-effective modality of pancreatic cancer screening. Numerous published AI models, such as the PANDA model, have detected pancreatic lesions on CT imaging with 92.9% sensitivity and 99.9% specificity [&lt;span&gt;6, 7&lt;/span&gt;]. The multi-center PANORAMA study has recently shown AI systems as superior to standard radiological assessment of pancreatic cancer (AUROC of 0.92 compared to 0.88 for radiologists) [&lt;span&gt;8&lt;/span&gt;]. Given the overlap in risk factors between pancreatic cancer and lung cancer, could the non-contrast imaging in the NLCSP be extended to the abdomen to perform AI-based screening for pancreatic cancer? However, given the taxonomy of harms of screening (physical effects, psychological effects, financial strain, and opportunity costs [&lt;span&gt;9&lt;/span&gt;]) for PDAC, an additional simple ancillary test with high specificity may be require","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2267-2269"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70852","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444182","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}