ANZ Journal of Surgery最新文献

{"title":"Utilizing Exudrain in the Minimally Invasive Management of Boorhaave's Syndrome.","authors":"William Fleischl, Waldron Martis, Suheelan Kulasegaran","doi":"10.1111/ans.70204","DOIUrl":"https://doi.org/10.1111/ans.70204","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148983","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":"25, 50 and 75 Years Ago.","authors":"Julian A Smith","doi":"10.1111/ans.70191","DOIUrl":"https://doi.org/10.1111/ans.70191","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135967","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":"Beneath the Surface: Facial Nerve Landmarks.","authors":"Ned Farley, Jake Hindmarch","doi":"10.1111/ans.70187","DOIUrl":"https://doi.org/10.1111/ans.70187","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135968","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":"Insights Into Rural Chemotherapy Usage for Muscle-Invasive Bladder Cancer: An Australian Multi-Site Institution Perspective.","authors":"Tran Ngoc An Huynh, Samiha Arulshankar, Xinyi Wei, Kylie Yen-Yi Lim, James Huang, Nieroshan Rajarubendra, Kevin Chu, Matthew Harper, Scott Donnellan, Weranja Ranasinghe","doi":"10.1111/ans.70175","DOIUrl":"https://doi.org/10.1111/ans.70175","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118677","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":"Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Therapy for Rectal Cancer: Cost Analysis in a Public Healthcare System.","authors":"Ishraq Murshed, Sergei Bedrikovetski, Ishmam Murshed, Zachary Bunjo, Tracy Fitzsimmons, Michelle Thomas, Tarik Sammour","doi":"10.1111/ans.70169","DOIUrl":"https://doi.org/10.1111/ans.70169","url":null,"abstract":"<p><strong>Purpose: </strong>Total neoadjuvant therapy (TNT) has become the standard of care in locally advanced rectal cancer, but its economic impact is unclear. This study compares the cost of TNT with conventional neoadjuvant therapy (CNT), consisting of either short-course radiotherapy or long-course chemoradiotherapy, within a universally funded public healthcare system.</p><p><strong>Methodology: </strong>A trial-based costing analysis was conducted from a third-party payer's perspective with a 2-year time horizon, following CHEERS guidelines. Consecutive patients with rectal cancer treated with neoadjuvant therapy from 2014 to 2023 were extracted from a multi-institutional database. Inpatient, outpatient, imaging and pathology resource costs were extracted and adjusted to 2024 AUD with a 5% discount rate. Primary outcomes were overall cost per cohort and mean per patient cost. Secondary outcomes were overall and mean cost per cost category. Sensitivity analysis explored the influence of discount rates and inflation methods.</p><p><strong>Results: </strong>Of 115 eligible patients, 60 (52.2%) received CNT and 55 (47.8%) received TNT. Overall treatment costs for the cohorts were $8 429 710.66 (CNT) and $6 992 616.67 (TNT), with mean per patient costs of $140 495.18 (CNT) and $127 138.48 (TNT). Overall per patient costs were $13 356.70 (9.51%) lower for TNT patients, mainly driven by lower mean inpatient costs ($78 523.53 vs. $96 843.08, 18.9%). TNT increased outpatient ($43 001.18 vs. $39 376.12, 9.21%), imaging ($4179.13 vs. $2973.61, 40.5%) and pathology ($1434.65 vs. $1302.38, 10.1%) costs. The results were robust to sensitivity analysis.</p><p><strong>Conclusion: </strong>TNT is less costly than CNT within a universally funded public healthcare system, primarily due to reduced inpatient costs associated with higher rates of organ preservation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118692","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":"Even in Australia and Aotearoa New Zealand, High-Volume Centres Deliver Best Outcomes for Oesophagectomy-Can We Ignore the Evidence?","authors":"David I Watson, Josipa Petric, Muktar Ahmed","doi":"10.1111/ans.70189","DOIUrl":"https://doi.org/10.1111/ans.70189","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109360","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 Chilled Versus Room Temperature Saline on Procedure Time and Postoperative Outcomes Following Coblation Intracapsular Tonsillectomy and Adenoidectomy in Children With Sleep Disordered Breathing: A Randomised Control Trial.","authors":"James Fowler, Nishan Chahal, Hamish Mckenzie, A Simon Carney","doi":"10.1111/ans.70180","DOIUrl":"https://doi.org/10.1111/ans.70180","url":null,"abstract":"<p><strong>Background: </strong>Using chilled saline as a medium for Coblation has been shown to reduce post-operative pain in both paediatric and adult extracapsular tonsillectomy. Its effect on the more minimally invasive intracapsular tonsillectomy (ICT) is unknown. A double-blind randomised controlled trial was performed to identify the effect of chilled saline on operation length, intra-/postoperative bleeding, postoperative pain and return to normal activity in paediatric Coblation ICT with adenoidectomy.</p><p><strong>Methods: </strong>Forty-two paediatric patients undergoing Coblation ICT and adenoidectomy for sleep-disordered breathing were randomly assigned to receive either room temperature (22.5°C) or chilled saline (3.8°C) as the Coblation plasma medium. Duration of surgery, intra-/postoperative bleeding, postoperative pain (using the Wong-Baker Pain Scale) and return to normal activity were recorded. Both the surgeon and patients/parents were blinded to the procedure arm.</p><p><strong>Results: </strong>Results had a nonparametric distribution and were analysed using a Mann-Whitney U test. Chilled saline extended median total procedure time (17.5 vs. 15 min; p < 0.05) when compared to room temperature saline. There was no statistically significant difference in postoperative pain, nor was there a difference in secondary outcomes: intra-/postoperative bleeding and return to normal activity.</p><p><strong>Conclusion: </strong>The use of chilled saline for paediatric Coblation ICT carries no advantages in terms of postoperative pain or bleeding. Chilled saline actually extends procedure time when compared to room temperature saline.</p><p><strong>Trial registration: </strong>Australian Clinical Trial Registry Number: ACTRN12624001267549.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109361","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 Pattern, Management, and Outcomes of Recurrence Following Cytoreductive Surgery for Pseudomyxoma Peritonei.","authors":"Rennie Xinrui Qin, Tilisi Puloka, Jia Hui Lim, Caro Staheli, Simione Lolohea, Jasen Ly, Jesse Fischer","doi":"10.1111/ans.70179","DOIUrl":"https://doi.org/10.1111/ans.70179","url":null,"abstract":"<p><strong>Backgrounds: </strong>We aimed to assess the pattern, management, and outcomes of recurrent pseudomyxoma peritonei (PMP) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and compare repeat and index CRS/HIPEC.</p><p><strong>Methods: </strong>A retrospective review was performed of patients undergoing CRS/HIPEC for PMP between 01/01/2008 and 30/06/2022 at a tertiary referral center in New Zealand. Multivariate logistic regression was used to identify independent predictors of repeat CRS/HIPEC. Overall survival (OS) of PMP recurrence was stratified according to management strategy.</p><p><strong>Results: </strong>Among 183 primary CRS/HIPEC for appendiceal PMP, 154 (84.2%) achieved complete cytoreduction. Median follow-up duration was 72.1 months. Forty-nine recurred (31.8%). 40 (81.6%) cases of recurrence were isolated to the peritoneal cavity, and 47 (95.9%) occurred within 5 years. 27 (55.1%) underwent repeat curative-intent surgery. 22 (44.9%) were managed with palliative intent. Age > 65 and high-grade carcinoma peritonei (HG) were independent negative predictors of repeat curative-intent surgery. Five-year overall survival was significantly higher in patients undergoing repeat curative-intent surgery (80.3%) compared to those managed with palliative intent (44.8%) (HR = 0.23, p < 0.001). Curative-intent repeat surgery was an independent predictor of overall survival in PMP recurrences. Compared to primary CRS/HIPEC, repeat CRS/HIPEC were less extensive procedures conducted in cases with a lower peritoneal cancer index. Repeat CRS/HIPEC had similar peri-operative morbidity and long-term survival to primary procedures.</p><p><strong>Conclusions: </strong>Repeat CRS/HIPEC for recurrent PMP is feasible and has similar safety and efficacy to index operations. Favorable long-term outcomes are achievable in well-selected patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109366","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":"Outcomes of Foundational Learning in Research Methods Following Primary Medical Qualification on Surgical Research: A Retrospective Review.","authors":"Meet Patel, David Sun, Maya Jane Starr, Dhaval Solanki, Jeet Upadhyay, Dominic J A Edwards, Arjun Raju, Thomas Maouris, Alexander Lombardo, Daphne Wang, Karamveer Nagi, Nazim Bhimani, Anthony R Glover","doi":"10.1111/ans.70184","DOIUrl":"https://doi.org/10.1111/ans.70184","url":null,"abstract":"<p><strong>Introduction: </strong>Limited knowledge exists on how post-graduate surgical coursework programs impact surgical research outputs in Australia. This study evaluated the impact of university-based teaching in research methods and supervisor characteristics on research quality and short-term research output for students undertaking the Master of Surgery (MS) post-graduate coursework degree within Australia.</p><p><strong>Methods: </strong>A retrospective cohort analysis of students enrolled in the dissertation for The University of Sydney MS program between 2010 and 2020. Grades for the dissertation and research subjects were extracted from the central university analytics. PubMed and Web of Science were used to determine if the dissertation was published and identify other publications by the students. A Google search was completed to identify supervisor characteristics. Statistical analysis involved logistic regression, multiple linear regression and negative binomial regression.</p><p><strong>Results: </strong>Three hundred and seventy-nine students were included in this study. Fifty-three percent of the students had an associated publication from their dissertation at a median of 18 months post-enrolment and a median journal impact factor of 2.19. Students averaged 2.1 additional publications (range 0-30) 2 years post-dissertation completion. Students with a distinction/high distinction grade in the dissertation subject or ≥ three journal publications prior were significantly more likely to publish their dissertation (OR 2.26, 95% CI = 1.42-3.61, p < 0.001; OR 3.35, 95% CI = 1.90-5.92, p < 0.001 respectively). Students who received a distinction/high distinction in the research methods subject had 64% more first-author publications within 2 years of finishing the dissertation (95% CI = 1.20-2.23, p = 0.002).</p><p><strong>Conclusion: </strong>Engagement in structured teaching in research methods and prior research experience significantly improve short-term research output amongst early surgical researchers.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092630","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":"Applying Machine Learning to the ANZELA-QI Database to Predict Adverse Outcomes for Patients Undergoing Emergency Laparotomy.","authors":"Dafydd Jones, Joshua Blum, Catherine Cartwright, Nikki Verhagen, Steven Xu, Benjamin Denholm, Lucinda Southcott, Richard Turner","doi":"10.1111/ans.70185","DOIUrl":"https://doi.org/10.1111/ans.70185","url":null,"abstract":"<p><strong>Background: </strong>Emergency laparotomy is associated with high rates of morbidity and mortality. Accurate, individualised risk prediction models can be used to improve shared decision-making, discharge planning and enhance patient flow. This study used the ANZELA-QI database to apply novel machine learning models to stratify the risk of adverse outcomes in patients undergoing emergency laparotomy.</p><p><strong>Methods: </strong>Data were extracted from the ANZELA-QI database. Three machine learning techniques were employed: logistic regression, XGBoost and random forest. Selected clinical and demographic predictor variables were used to train and test the machine learning models in the prediction of mortality, post-operative ICU admission, non-return home and prolonged hospitalisation.</p><p><strong>Results: </strong>A total of 8615 cases from 35 hospitals was available from the ANZELA-QI database. Complete data were available in 5195 cases for mortality, ICU admission and non-return home outcomes, and 4469 cases for length of stay. In this cohort 2175 (42%) were admitted to ICU, 601 (12%) died, 1483 (29%) did not return to usual place of residence and 2983 (67%) were admitted for over 1-week post-operatively. Machine learning models demonstrated the greatest accuracy in the prediction of ICU admission and length of stay. The sensitivity and specificity for ICU admission were 0.7 and 0.74, respectively. For admission longer than one week, the overall accuracy was 75%.</p><p><strong>Conclusion: </strong>This study applied novel machine learning programs to the ANZELA-QI database to develop risk stratification models for adverse outcomes in patients undergoing emergency laparotomy. The results showed high accuracy for the prediction of prolonged length of stay and post-operative ICU admission.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092626","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}