ANZ Journal of Surgery最新文献

{"title":"The Effect of Watching Surgical Videos on the Internet on Preoperative Anxiety in Patients Undergoing Elective Inguinal Hernia Surgery","authors":"Asim Kocabay,&nbsp;Celil Ugurlu,&nbsp;Fatih Dasiran,&nbsp;Namik Ozkan,&nbsp;Salih Yilmaz,&nbsp;Hakan Kulacoğlu","doi":"10.1111/ans.70889","DOIUrl":"10.1111/ans.70889","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to compare the anxiety levels of patients diagnosed with inguinal hernia in the outpatient clinic and scheduled for surgery by questioning those who watched a video about the upcoming surgery on social media platforms with their own means and those who did not before the operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Patients who were scheduled for elective inguinal hernia surgery at Tokat Gaziosmanpaşa University Hospital's General Surgery Clinic between December 2023 and May 2024 were included in the study. They were divided into two groups based on if they watched a surgical video on any social media platform before the surgery or did not. The patients were asked about their age, gender, educational level, prior surgery history, whether they previously underwent inguinal hernia surgery, which social media platform they watched the surgical video on, whether they watched the entire video, how watching the surgical video affected their anxiety levels, and whether they found the posting of such videos on social platforms to be beneficial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 185 patients who were given the questionnaire, 171 patients (92.4%) responded. Of the patients, 52 watched surgical videos, while 119 (69.5%) did not. It was determined that among those who watched a video of the surgical procedure, the mean age was significantly lower (<i>p</i> &lt; 0.001), and the educational level was significantly higher (<i>p</i> = 0.013). In addition, the state anxiety level of patients who watched a related video was found to be significantly higher than that of those who did not (<i>p</i> = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients scheduled for elective surgery due to inguinal hernia, watching videos of surgical procedure on social media platforms before the procedure did not affect their trait anxiety level but significantly increased their state anxiety level. Therefore, we recommend that videos presented to patients via social media be prepared by healthcare professionals who filter them through a certain level of education and expertise before they are offered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2292-2299"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688483","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":"From Shocks to Scopes: National Trends in Stone Surgery in Australia.","authors":"Basil Razi, Cheryl Fung, Catalina Alejandra Palma, Henry H Woo, Simon Bariol","doi":"10.1111/ans.70980","DOIUrl":"https://doi.org/10.1111/ans.70980","url":null,"abstract":"<p><strong>Introduction: </strong>The surgical management of nephrolithiasis in Australia has changed markedly over the past three decades. Extracorporeal shock wave lithotripsy (SWL), once the dominant modality, has been progressively supplanted by advances in ureteroscopy (URS), flexible pyeloscopy and percutaneous nephrolithotomy (PCNL). This study aimed to characterise Australian trends in stone surgery between 1994 and 2024, examining changes in the relative utilisation of SWL, endoscopic, PCNL and non-endoscopic procedures, contextualised against population growth.</p><p><strong>Methods: </strong>Annual national counts were extracted from the Australian MBS between 1994 and 2024 for SWL, URS, flexible pyeloscopy, PCNL, nephro/pyelolithotomy and ureterolithotomy. Descriptive statistics and temporal trend analyses were performed. Australian Bureau of Statistics data were used for population context. Compound annual growth rates (CAGR) described long-term changes. As publicly available, de-identified data were analysed; ethics approval was not required.</p><p><strong>Results: </strong>A total of 393 415 procedures were performed between 1994 and 2024. Over this period, the Australian population grew by 53%, while stone surgery rates increased 3.5-fold, from 26 to 89 per 100 000. SWL peaked in 2002 and declined by 48%, accounting for 7.4% of all procedures in 2024. URS volumes rose sevenfold, while pyeloscopy rose rapidly from 2001, surpassing SWL by 2009. PCNL volumes remained stable whilst open/laparoscopic lithotomy procedures declined. Total procedures increased at a CAGR of 5.6%, driven primarily by endoscopic modalities.</p><p><strong>Conclusion: </strong>Australian stone surgery has transitioned decisively from SWL to endoscopic management over the past 30 years, with intervention rates rising well beyond population growth. These trends reflect technological advances and increasing preference for minimally invasive treatment, with significant implications for future workforce planning and resource allocation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036160","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":"Parastomal Hernia: Rethinking Prevention and Repair in Contemporary Colorectal Surgery","authors":"Rathin Gosavi,&nbsp;Thang Chien Nguyen,&nbsp;Paul McMurrick,&nbsp;William Teoh,&nbsp;Vignesh Narasimhan","doi":"10.1111/ans.70687","DOIUrl":"10.1111/ans.70687","url":null,"abstract":"&lt;p&gt;Parastomal hernia (PSH) remains the most common long-term complication following permanent stoma formation. Reported incidence exceeds 50% in long-term follow-up cohorts [&lt;span&gt;1, 2&lt;/span&gt;]. Although many hernias remain asymptomatic, clinically significant PSH can lead to pain, stoma dysfunction, appliance-related difficulties and, in some cases, obstruction or strangulation requiring urgent intervention [&lt;span&gt;1&lt;/span&gt;]. The condition affects quality of life and increases healthcare utilisation [&lt;span&gt;3-5&lt;/span&gt;]. However, it remains both challenging to prevent and difficult to manage definitively.&lt;/p&gt;&lt;p&gt;Despite increasing interest in prophylactic and reparative strategies, there is no universally accepted standard for prevention or repair [&lt;span&gt;2&lt;/span&gt;]. Recent randomised trials [&lt;span&gt;6-10&lt;/span&gt;] have raised doubts about the long-term efficacy of prophylactic mesh reinforcement, whereas repair techniques continue to evolve in a landscape shaped by surgeon experience, institutional resources and patient-centred considerations. This perspective benchmarks contemporary Australian and New Zealand practice, as described in a recently published binational CSSANZ survey [&lt;span&gt;11&lt;/span&gt;], against current international guideline recommendations for PSH prevention and repair. Areas of alignment and discordance are highlighted, and potential drivers of practice variation are explored. Based on these observations, we propose a pragmatic framework to support evidence-informed, context-sensitive decision-making.&lt;/p&gt;&lt;p&gt;The construction of a stoma, particularly in the emergency setting, is frequently delegated to junior trainees under supervision and training in ostomy site selection can be inconsistent [&lt;span&gt;12&lt;/span&gt;]. Technical decisions at this point, including siting within the rectus, fascial incision configuration, trephine diameter and fixation method, influence downstream parastomal hernia risk [&lt;span&gt;1, 13&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;There is general agreement that the stoma should traverse the rectus abdominis muscle and that the skin marking and siting process be deliberate and protocolised [&lt;span&gt;12, 14&lt;/span&gt;]. The fascial aperture should be calibrated to minimise tension while avoiding constriction; larger defects are associated with higher hernia risk, although precise thresholds remain uncertain [&lt;span&gt;13, 15&lt;/span&gt;]. Although robust evidence is limited, many surgeons favour a linear vertical fascial incision and controlled trephine diameters (typically 21–25 mm for end ileostomy and 26–30 mm for end colostomy) based on principles of mechanical advantage and tissue preservation [&lt;span&gt;15, 16&lt;/span&gt;]. A uniform approach to technical details, supported by institutional protocols, may reduce variability and optimise outcomes [&lt;span&gt;12, 14&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The concept of prophylactic mesh placement at the time of end stoma formation has been examined extensively in elective end colostomy settings. Early single-centre randomised trials suggested reductio","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2270-2273"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697458","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":"The Beginning of the End?","authors":"Guy Maddern","doi":"10.1111/ans.70850","DOIUrl":"10.1111/ans.70850","url":null,"abstract":"&lt;p&gt;The passing of RACS at 100 years is not to be celebrated as a life well lived but rather a tragic death of an organisation with immense promise. Born in 1927 with two parents from New Zealand and Australia, the Royal Australasian College of Surgeons (RACS) was created to set standards and provide training for medical practitioners wanting to pursue a surgical career. It was always intended to cover the breadth of surgical practice. Its admission process allowed overseas qualifications to be recognised, along with Australian and New Zealand university postgraduate surgical qualifications, wartime training and ultimately developed its own unique Fellowship.&lt;/p&gt;&lt;p&gt;It gave birth to a College of Anaesthetists, allowed ophthalmology to become independent, survived the Australian Medical Council (AMC) scrutiny, followed shortly after by the Australian Competition and Consumer Commission (ACCC) concerns of monopolising surgical training [&lt;span&gt;1&lt;/span&gt;]. It has had to deal with the introduction of Medicare, fee gouging, Government short-term goals, potential College financial ruin, private hospital training, bullying and sexual harassment and unscrupulous surgical practices by surgeons.&lt;/p&gt;&lt;p&gt;The glue that holds RACS together is the ‘craft of surgery’ which is focussed on the best care for surgical patients. There can be no quarter given for financial greed, personal aggrandisement or denigrating surgical colleagues. Standing up to Government, the media, rogue surgeons and conservative mindsets is not easy. For medical colleges generally, and RACS in particular, failure to withstand assault, ill-considered change at the expense of patient care and surgical reform is why the College was created.&lt;/p&gt;&lt;p&gt;Fellowship of the Royal Australasian College of Surgeons (FRACS) took over a generation to create and, while not perfect, stands as one of the most highly regarded badges of surgical training and practice on the planet. When faced with a patient suffering from a life-threatening condition, the surgical team rises to the occasion to develop a strategy that solves the clinical problem. We are very talented at developing new approaches and strategies to improve patient care. Unfortunately, when it comes to RACS, instead of looking for solutions that provide both nations with an excellent surgical organisation focussed on surgical patient care, it is struggling to hold Fellows and some craft groups to task and to uphold professionalism. Some factions do not care enough about the profession and decide to weaken the structure that has delivered outstanding leadership and play into the hands of those who would welcome a divided faction-riddled cabal of surgeons. If the College is to be a champion of advocacy, training and standards in the future, it needs to stand up and bring into line those who would bite the hand that feeds because they don't care, don't understand, or focus on their material gain. Most just want to be the best surgeon possible, working in a ","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"96 9","pages":"2250-2251"},"PeriodicalIF":1.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ans.70850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410175","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":"Inguinal Hernia Repair Under Local Anesthesia: Benefits, Contraindications, Barriers to Use; A Narrative Review.","authors":"Seyed Ahmad Masoumi Lari, Niloufar Roustaei","doi":"10.1111/ans.70962","DOIUrl":"https://doi.org/10.1111/ans.70962","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is a common surgery worldwide. Despite the advantages of local anesthesia, many healthcare providers avoid using this method due to several barriers relating to patients, surgical team, and operating rooms.</p><p><strong>Method: </strong>A review of studies published in PubMed and Google Scholar was conducted to examine outcomes, costs, patient satisfaction, safety, and barriers associated with the use of local anesthesia for inguinal herniorrhaphy.</p><p><strong>Results: </strong>Local anesthesia was associated with many advantages including less postoperative pain, fewer complications, shorter hospital stay, lower healthcare costs, and safer in high-risk patients compared with spinal and general anesthesia. New methods such as tumescent local anesthesia and the combination of hypnosis and conscious sedation with local anesthesia enhance the effectiveness and safety of local anesthesia, improving both surgeon and patient experience. Selected studies demonstrated that using local anesthesia in some traditional contraindications such as obesity and recurrent cases is a safe and effective option. Despite the strong evidence, there are some barriers that limit the use of local anesthesia including patient anxiety, intraoperative pain, surgeon discomfort, staff communication problems, logistic issues, and lack of institutional protocols.</p><p><strong>Conclusion: </strong>Local anesthesia is a safe and cost-effective method for inguinal hernia repair. To facilitate the routine use of local anesthesia, it is crucial to address the barriers through training the surgical team, the development of standardized protocols and logistics, and enhanced patient awareness.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023714","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":"Burns in Incarcerated Adults: A 10-Year Retrospective Review From an Australian Quaternary Burns Centre.","authors":"Andrew Robertson, Alexandra Boyling, Miranda Pye, Shevani Pothugunta, Joanneke Maitz","doi":"10.1111/ans.70973","DOIUrl":"https://doi.org/10.1111/ans.70973","url":null,"abstract":"<p><strong>Background: </strong>Burn injuries sustained in custodial settings are poorly characterised within the Australian literature despite unique environmental and behavioural risk factors associated with incarceration. Scald burns related to interpersonal violence appear increasingly recognised within correctional facilities; however, their clinical characteristics, management requirements and outcomes remain inadequately described. This study aimed to characterise burns sustained by incarcerated adults treated at an Australian quaternary burns centre.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of incarcerated adults treated at the Concord Repatriation General Hospital Burns Unit between January 2016 and February 2026. Patients were identified through the NSW Statewide Burn Injury Service registry and cross-referenced with electronic medical records. Demographic characteristics, injury mechanism, burn severity, management and clinical outcomes were analysed. Patients were stratified by injury intent (assault vs. non-assault) for comparative analysis.</p><p><strong>Results: </strong>Forty-four patients met inclusion criteria. Median age was 32.5 years and 84.1% were male. Scald burns accounted for 81.8% of injuries, with assault responsible for 75.0% of all burns and 88.9% of scald injuries. Median TBSA was 4.8% (IQR 1.0-7.8), yet procedural intervention was required in 45.5% of patients. Burns most commonly involved the head and neck (56.8%), upper limbs (50.0%) and trunk (47.7%). Adequate burns first aid was provided in only 38.6% of cases. Assault-related injuries were associated with larger TBSA, increased burns unit admission, longer hospital stay and higher operative rates than non-assault injuries.</p><p><strong>Conclusions: </strong>Burn injuries in incarcerated adults represent a distinct and largely preventable injury subtype characterised predominantly by assault-related scald burns, inadequate first aid, frequent delays in presentation and high procedural requirements relative to burn size. Prevention initiatives, staff education and streamlined referral pathways within custodial healthcare systems may reduce preventable morbidity and improve outcomes in this high-risk population.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023711","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":"Subtotal Cholecystectomy: Outcomes of a Fenestrated Versus Reconstituted Approach and the Association With Cystic Duct Findings on Cholangiogram.","authors":"Tze Hee Tay, Chantal Campbell, Julia Guerrero, Ramesh Damodaran Prabha, David Parker, Michelle Cooper, Stephen Guy","doi":"10.1111/ans.70985","DOIUrl":"https://doi.org/10.1111/ans.70985","url":null,"abstract":"<p><strong>Background: </strong>Subtotal cholecystectomy (STC) is a recognised bailout strategy when the critical view of safety cannot be safely achieved. Whether cystic duct findings on intraoperative cholangiogram (IOC) should guide the choice between performing a fenestrated or a reconstituted STC remains unclear. This study evaluates the relationship between IOC results, STC technique and postoperative outcomes over a 17-year period.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted across the Gold Coast Hospital and Health Service (2006-2023). Variables examined included demographics, cystic duct patency on attempted IOC, STC technique, length of stay, readmission, cost and complications including bile leak, remnant cholecystitis, ERCP, return to theatre and medical complications.</p><p><strong>Results: </strong>Out of 10 964 cholecystectomies, 181 (1.65%) were STC. Reconstituted STC was performed in 157 of these cases (87%) and fenestrated in 24 (13%). 25% of patients had a patent cystic duct on IOC, while the remaining 75% of patients had a non-patent or indeterminate cystic duct. The association between a patent cystic duct and the risk of surgical complications when compared to a non-patent or indeterminate cystic duct did not reach statistical significance (OR 0.69, p = 0.35). Similarly, there was no statistically significant association between STC technique and surgical complications (OR 0.48, p = 0.10).</p><p><strong>Conclusion: </strong>Neither cystic duct findings on IOC nor STC technique were associated with a difference in outcomes. Surgeons in our institution were more likely to utilise a reconstituted STC technique in preference to fenestrated. Both approaches represent safe bailout options in these challenging cases.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015257","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":"Prior Surgical Experience as a Predictor of Preoperative Anxiety, Early Postoperative Pain, and Analgesic Use.","authors":"Gönül Yilmaz-Dündar, Mustafa Örmeci","doi":"10.1111/ans.70986","DOIUrl":"https://doi.org/10.1111/ans.70986","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined whether prior surgical experience predicts preoperative anxiety, early postoperative pain intensity, and analgesic use in patients undergoing laparoscopic cholecystectomy.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Methods: </strong>The study was conducted between April and December 2025 in the General Surgery Clinic of a tertiary training and research hospital and included 310 patients undergoing laparoscopic cholecystectomy. Data were collected using a Patient Information Form, the Visual Analog Scale (VAS), an analgesic use chart, and the Surgical Anxiety Scale. Descriptive statistics, linear regression, and logistic regression analyses were performed to examine predictive relationships among the variables.</p><p><strong>Results: </strong>Patients without prior surgical experience reported significantly higher preoperative anxiety levels and higher postoperative pain scores at all measured time points compared with experienced patients (p < 0.05). In multivariate analysis, lack of prior surgical experience was an independent predictor of increased postoperative pain intensity (B = -1.978, p < 0.001) and opioid use. Patients with prior surgical experience had a 70.9% lower likelihood of opioid use compared with those without experience (OR = 0.291, p < 0.001). Additionally, higher preoperative anxiety was independently associated with increased postoperative pain intensity (B = 0.072, p < 0.001) and greater odds of opioid use (OR = 1.057, p < 0.001).</p><p><strong>Conclusions: </strong>Prior surgical experience appears to play a protective role in early postoperative outcomes. Patients undergoing surgery for the first time may represent a higher-risk group requiring structured preoperative assessment and individualized, anxiety-informed pain management planning.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015290","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":"Correlation of 3T Magnetic Resonance Imaging Neurogram to Histology for Large Nerve Perineural Spread From Cutaneous Squamous Cell Carcinoma of the Head and Neck.","authors":"Mai N Tran, Ryan Sommerville, Karen Hay, Touraj Taheri, Jennifer Gillespie, Charles Lin","doi":"10.1111/ans.70943","DOIUrl":"https://doi.org/10.1111/ans.70943","url":null,"abstract":"<p><strong>Introduction: </strong>Cutaneous Squamous Cell Carcinoma (cSCC) is a major health issue in Australia. Perineural spread (PNS) in cSCC carries a worse prognosis. Magnetic Resonance Imaging (MRI) neurogram is the best imaging modality to detect and define the zonal extent of PNS, although histology remains the diagnostic gold standard.</p><p><strong>Aims: </strong>Investigate the agreement between the detection of PNS on MRI and the histology of the resected nerve. We also assess the agreement of MRI zoning with the histological zoning based on William's definition and our department's modified classification system.</p><p><strong>Methods: </strong>We conducted a retrospective review of consecutive patients with PNS from cSCC of the head and neck. Patients included had PNS on MRI neurogram and histology of the suspected nerve for review.</p><p><strong>Results: </strong>Seventy patients were included, with 90 suspected involved nerves reviewed. Two nerves considered involved with PNS on MRI were not involved on histology. The positive predictive value of MRI neurogram was 98%. Three nerves were negative on MRI but positive on histology, resulting in a 97% positive agreement. The observed zonal agreement was 83% based on William's zonal classification and 69% with our institution's modified zonal classification system. With the latter system, the agreement for zones 1, 2a and 2b PNS was 85%, 50% and 40% respectively.</p><p><strong>Conclusion: </strong>3T MRI neurogram is an effective modality to detect PNS in cSCC of the head and neck region. The accuracy of MRI to sub-define zones 2a and 2b requires further study.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015285","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 Single Viable Hepatocellular Carcinoma ≤ 3 cm on Survival After Liver Transplantation.","authors":"Lauren C Y Tang, Eunice Lee, Avik Majumdar, Ted Stoklosa, Danny Con, William Chung, Emily Nash, Adam Testro, Michael Fink, Simone Strasser, Ken Liu, David G Bowen, Marie Sinclair","doi":"10.1111/ans.70982","DOIUrl":"https://doi.org/10.1111/ans.70982","url":null,"abstract":"<p><strong>Background: </strong>The risks of recurrent hepatocellular carcinoma (HCC) and HCC-specific mortality post-liver transplant (LT) are influenced by the number and size of viable tumours. This study assesses HCC-specific mortality post-transplant for patients in two groups-those with no viable disease versus single viable tumour ≤ 3 cm, as assessed on most recent imaging prior to transplantation.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients transplanted for the indication of HCC between 1998 and 2018 at two Australian centres. Competing risks regression assessed 5-year HCC-specific mortality, with the competing risk of non-HCC-specific mortality.</p><p><strong>Results: </strong>There was a significantly lower 5-year HCC-specific mortality post-transplant for those with no viable disease (n = 152) versus single viable tumour ≤ 3 cm (n = 145) (4.0% vs. 10.5%, SHR 2.72, 95% CI: 1.06-6.98, p = 0.038) on univariable analysis. On multivariable competing risks analysis, the modified Response Evaluation Criteria In Solid Tumour (mRECIST) criteria and higher AFP level at transplant were significant predictors of 5-year HCC specific mortality, with progressive disease (aSHR 16.33, 95% CI: 2.35-113.6, p = 0.005) and stable disease (aSHR 10.26, 95% CI: 1.81-58.2, p = 0.0012) having a higher risk than complete response; whilst the significance of no viable disease versus single viable tumour ≤ 3 cm was not significant on multivariable analysis.</p><p><strong>Conclusions: </strong>There was a significantly lower 5-year HCC-specific mortality for those with imaging showing no viable disease versus single viable tumour ≤ 3 cm, prior to transplantation. Lower HCC-specific mortality was demonstrated for those with a lower AFP level and those in radiological complete response at time of transplant.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011925","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}