ANZ Journal of Surgery最新文献

{"title":"Multidisciplinary Colorectal Cancer Care in Regional Australia: A Practical Pathway.","authors":"Naseem Bhorat, Daniel Cattanach, Michelle Chen, Juyong Cheong, Heng-Chin Chiam, Julie Flynn, Ricardo Hamilton, Howard Joy, Rob Knox, Michael Lamparelli, David Mackrill, Masselan Naidoo, Pieter Prinsloo, Boris Ruggiero, Nicholas Smith","doi":"10.1111/ans.70958","DOIUrl":"https://doi.org/10.1111/ans.70958","url":null,"abstract":"","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":"149011937","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":"Adhesive Bowel Obstruction Following Discontinuation of Gastrografin: Time for an Alternative Pathway.","authors":"Omar Abu Saadeh, Hugo C Temperley, Padraig Cronin, Zi Qin Ng","doi":"10.1111/ans.70981","DOIUrl":"https://doi.org/10.1111/ans.70981","url":null,"abstract":"","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":"149011946","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 the Australian National Bowel Cancer Screening Program on Stage at Diagnosis and Stage-Specific Survival in Colorectal Cancer.","authors":"Michael Rouse, Michael Harold, Vanessa Wong, Margaret Lee, Fiona Reid, Justin M Yeung, Peter Gibbs, Ian Faragher","doi":"10.1111/ans.70984","DOIUrl":"https://doi.org/10.1111/ans.70984","url":null,"abstract":"<p><strong>Aim: </strong>The Australian National Bowel Cancer Screening Program began in 2006, offering free faecal occult blood testing every 2 years to Australians aged 50-75 years. We hypothesised a difference in overall survival between screen-detected and non-screen-detected colorectal cancer in an Australian cohort, for each stage I-III.</p><p><strong>Methodology: </strong>A retrospective cohort study of patients with stage I-III colorectal cancer from 2010 to 2024 was conducted using a prospectively maintained institutional database. Overall survival (OS) was calculated from the date of diagnosis. Kaplan-Meier analysis and log-rank testing were used to compare survival between screen-detected and non-screen-detected cancers, stratified by stage.</p><p><strong>Results: </strong>A total of 881 colorectal cancer episodes were included, of which 254 (28.8%) were screen-detected. The proportion of screen-detected cancers increased significantly over time (Cochran-Armitage trend test, p < 0.001). Screen-detected cancers were diagnosed at an earlier stage, with a significantly higher proportion of stage I disease than non-screen-detected cancers (38.6% vs. 18.0%, p < 0.001). Five-year OS for stage I disease was 93.9% in the screen-detected group and 90.8% in the non-screen-detected group (HR 0.62, 95% CI 0.30-1.28; p = 0.19). Corresponding five-year OS for stage II disease was 91.3% and 85.6%, respectively (HR 0.70, 95% CI 0.33-1.48; p = 0.35). In stage III disease, 81.5% vs. 68.9%, respectively (HR 0.56, 95% CI 0.34-0.92; p = 0.02).</p><p><strong>Conclusions: </strong>Screen-detected colorectal cancer is associated with earlier stage at diagnosis and improved survival in stage III disease. These findings support the role of screening in earlier diagnosis and improved oncological outcomes.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001192","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":"Marius Fahrer: Possibly the Last Australian Surgeon-Anatomist and His Valued and Varied Legacy.","authors":"Norman Eizenberg, Ritesh Chimoriya, Elizabeth Milford, Wayne Morrison, Claude N Fahrer, Aude M Fahrer, Pierre Chapuis","doi":"10.1111/ans.70955","DOIUrl":"https://doi.org/10.1111/ans.70955","url":null,"abstract":"<p><p>This article commemorates the life and works of Marius Fahrer MD (Bucharest), MB, BS(Qld), FRACS, FAFRM, possibly one of the last few Australian 'surgeon-anatomists' whose career brought together anatomical scholarship, hand surgery and surgical education. Born in Bucharest in 1927, Fahrer emigrated to Australia via Paris in 1963 as a political refugee. Despite challenges with medical registration and limited English, he secured a position at the University of Queensland after an unusual interview with Professor Max Hickey, conducted largely in Latin. Fahrer subsequently requalified medically in Australia whilst maintaining surgical expertise through sabbaticals in Queensland, France and Germany. His collaboration with Raoul Tubiana at the Institute of Hand Surgery in Paris proved substantial, contributing to the seminal English translation of Tubiana's five-volume treatise on hand surgery. Throughout his distinguished career, Fahrer championed cadaveric dissection in surgical education, mentored countless trainees and served as Honorary Curator of the Cowlishaw Collection, receiving both the ESR Hughes Award and the Kenneth Russell Medal for his outstanding contributions. Widely respected in Australia and internationally, Fahrer's career exemplified the integration of anatomical scholarship with surgical innovation at a time when surgical subspecialisation was rapidly developing. His influence as a teacher, mentor, and an advocate for anatomy-based surgical education left a lasting legacy for subsequent generations of hand surgeons and anatomists.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001148","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":"Topical Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis of Postoperative Bleeding Outcomes.","authors":"Sina Sobhanmanesh, Femi E Ayeni, Deborah S M Cheung","doi":"10.1111/ans.70968","DOIUrl":"https://doi.org/10.1111/ans.70968","url":null,"abstract":"<p><strong>Background: </strong>Haematoma and seroma formation are recognised postoperative complications following breast surgery. Tranexamic acid (TXA), an antifibrinolytic agent widely used in other surgical specialties, has not yet been routinely adopted in breast surgery. This systematic review and meta-analysis evaluated the effect of topical TXA on postoperative outcomes in breast surgery.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase and Cochrane CENTRAL were searched from inception to February 2026 using the terms (tranexamic OR TXA) AND breast AND topical. Outcomes included postoperative haematoma, seroma and drain output. Random-effects meta-analysis was performed to calculate mean differences and risk ratios (RRs).</p><p><strong>Results: </strong>Seven studies (five randomised controlled trials and two cohort studies) involving 1258 breasts (629 topical TXA and 629 controls) were included. Meta-analysis demonstrated a significant reduction in postoperative drain output with topical TXA (mean difference -16.22 mL; 95% CI: -26.54 to -5.91; p = 0.002). Topical TXA was associated with a 75% reduction in haematoma risk (RR 0.25; 95% CI: 0.08-0.72; p = 0.01). Seroma rates did not differ significantly between groups (p = 0.26). Subgroup analysis by procedure type showed numerically greater effects in mastectomy cohorts, with no significant subgroup differences for drain output (p = 0.31) or haematoma (p = 0.19). No TXA-related adverse events were reported.</p><p><strong>Conclusion: </strong>Topical tranexamic acid appears to be a safe adjunct in breast surgery, reducing postoperative drain output and haematoma formation. Larger, high-quality randomised controlled trials are needed to validate these findings and establish standardised protocols.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001123","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":"Risk Assessment of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasm Harboring Multiple Worrisome Features and High-Risk Stigmata: A Single-Center Cohort Study.","authors":"Zhen Liu, Liping Cao","doi":"10.1111/ans.70976","DOIUrl":"https://doi.org/10.1111/ans.70976","url":null,"abstract":"<p><strong>Backgrounds: </strong>Pancreatic intraductal papillary mucinous neoplasm (IPMN) with multiple risk features, including worrisome features (WFs) and high-risk stigmata (HRS), may have a higher probability of malignant transformation. This study aimed to evaluate the risk of progressing to invasive carcinoma (IC) in IPMN patients.</p><p><strong>Methods: </strong>This study collected data from IPMN patients who received regular monitoring at our hospital between June 2017 and January 2025, with a monitoring duration of more than 6 months. The changes in risk features and progression to IC during monitoring were recorded.</p><p><strong>Results: </strong>IPMN patients with > 2 WFs or HRS had a higher probability of presenting with IC. Univariate and multivariate Cox regression analyses revealed that > 2 WFs (HR = 22.65, 95% CI: 4.28-119.83, p < 0.001) and HRS (HR = 17.39, 95% CI: 3.76-80.44, p < 0.001), family history of pancreatic carcinoma (HR = 5.35, 95% CI: 1.68-17.05, p = 0.005), serum carbohydrate antigen 19-9 (CA19-9) level (HR = 1.01, 95% CI: 1.01-1.01, p = 0.039), cyst growth rate (HR = 1.12, 95% CI: 1.06-1.19, p < 0.001), and main pancreatic duct (MPD) dilatation rate (HR = 1.26, 95% CI: 1.09-1.46, p = 0.002) were independent risk factors associated with malignant progression of IPMN.</p><p><strong>Conclusion: </strong>Intensified monitoring should be performed for IPMN patients carrying > 2 WFs or HRS. Discontinuation of surveillance should be carefully considered in patients without any risk features. Cyst growth rate and MPD dilatation rate are critical risk factors that require focused assessment during the monitoring of IPMN patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987839","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":"Temporary Mesocaval Shunt: A Surgical Strategy to Facilitate Pancreatic Cancer Resection With Complex Vascular Involvement.","authors":"Moath Alarabiyat, Sarah Powell-Brett, Saad Rehman, Peter Labib, Ravi Marudanayagam, Bobby Dasari, Syed Soulat Raza, David Bartlett, Keith Roberts, Robert Sutcliffe, Nikolaos Chatizacharias","doi":"10.1111/ans.70977","DOIUrl":"https://doi.org/10.1111/ans.70977","url":null,"abstract":"<p><strong>Background: </strong>Extensive vascular involvement remains a major challenge in the surgical management of borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Temporary mesocaval shunting (tMCS) may facilitate resection in cases of mesenteric venous occlusion or collateralisation and improve exposure of the superior mesenteric artery; however, its use in pancreatic surgery is rarely reported.</p><p><strong>Methods: </strong>We performed a retrospective case series of patients with borderline or locally advanced PDAC who underwent curative-intent resection with intra-operative tMCS between 2017 and 2022. Demographics, perioperative outcomes, post-operative complications and survival were analysed using the Kaplan-Meier method.</p><p><strong>Results: </strong>Six patients underwent pancreatectomy with tMCS (three pancreaticoduodenectomies, three total pancreatectomies). Median age was 58.5 years. All shunts used cryopreserved cadaveric iliac vein grafts. Median length of stay was 13 days. Two patients (33%) developed Clavien-Dindo grade ≥III complications, including one post-operative death. R0 resection was achieved in two patients (33%). Median overall survival was 24.8 months (33.2 months excluding post-operative mortality), and median disease-free survival was 8 months.</p><p><strong>Conclusion: </strong>Selective tMCS may enable resection in PDAC with extensive vascular involvement. This complex approach should be reserved for carefully selected patients at high-volume centres with vascular expertise.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Do an Arthrogram Following Open Arthrotomy of the Paediatric Elbow-Indications and Technique.","authors":"Daniel Joel Epstein, Kemble K Wang","doi":"10.1111/ans.70956","DOIUrl":"https://doi.org/10.1111/ans.70956","url":null,"abstract":"<p><p>Arthrography is a vital tool in paediatric elbow surgery to accurately visualise the articular surface and assess joint stability. This is particularly relevant following open arthrotomies for procedures correcting joint alignment. We describe a reproducible, simple technique for performing elbow arthrography after open arthrotomy of the paediatric elbow, accompanied by illustrative images and a video demonstration.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966410","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":"Long-Term Outcomes of Patients With Adductor-Related Groin Pain: Assessing the Clinical Relevance of Imaging-Only Hernias.","authors":"Daniel O'Connor, Nazim Bhimani, Amanda Turner, Thomas J Hugh","doi":"10.1111/ans.70966","DOIUrl":"https://doi.org/10.1111/ans.70966","url":null,"abstract":"<p><strong>Background: </strong>Groin pain is a common and diagnostically challenging presentation. Imaging often detects hernias that are not clinically evident ('imaging-only hernias') which can lead to unnecessary surgical intervention and under-diagnosis of musculoskeletal conditions like adductor-related groin pain (ARGP). This study evaluates long-term outcomes of patients diagnosed with ARGP in a variety of settings.</p><p><strong>Methods: </strong>This was a retrospective study of patients diagnosed with ARGP (between January 2021 and June 2024) using the Groin-MAP. Patients were categorised into groups: (1) ARGP with imaging-only hernia, (2) ARGP with clinical inguinal hernia and (3) ARGP following inguinal hernia repair. Long-term patient-reported outcome measures were assessed.</p><p><strong>Results: </strong>Follow-up was completed for 110 of 133 eligible patients at a median of 29 months (range 10-66). Group 1 (n = 47) reported 90% satisfaction after management of their adductor pain alone; only 1/47 had a hernia repair elsewhere. Group 2 (n = 29) reported 90% satisfaction with equivalent management of ARGP, but varied management for inguinal hernia. Up-front hernia repair was opted for by 14/29 and 15/29 opted for watchful waiting, of which 2 progressed to surgery. Group 3 (n = 34) had a higher symptom burden; yet 70% maintained mild or no activity limitation and 1/34 had revision hernia surgery.</p><p><strong>Conclusion: </strong>ARGP is under-recognised as a cause of groin pain in surgical practice, and is best diagnosed on physical examination. Patients with ARGP have good long-term outcomes without intervention for incidental imaging-only inguinal hernias. Those with clinical inguinal hernias might delay or avoid surgical repair by addressing concomitant ARGP.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966320","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":"Robotic- Versus Video-Assisted Thoracoscopic Lobectomy and Persistent Air Leak: A Systematic Review and Meta-Analysis.","authors":"Alexander Lombardo, Angela Chen","doi":"10.1111/ans.70940","DOIUrl":"https://doi.org/10.1111/ans.70940","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive approaches are widely adopted for anatomical lung resection in early-stage non-small cell lung cancer, with video-assisted thoracoscopic surgery (VATS) representing the established standard. Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative platform, although its clinical advantages remain uncertain. Persistent air leak (PAL) is a common complication following lobectomy, occurring in up to 8%-19% of patients and contributing to prolonged hospitalization and morbidity. Prior comparative studies of RATS and VATS have been limited by heterogeneity in operative procedures and inclusion of sublobar resections. This study aimed to compare PAL following RATS versus VATS lobectomy, restricting inclusion to lobectomy-only cohorts to reduce procedural heterogeneity.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of studies comparing RATS and VATS lobectomy was performed. Exclusively lobectomy-only cohorts were included to reduce procedural heterogeneity. The primary outcome was PAL (> 5 days). Random-effects models were used to calculate pooled risk ratios (RR).</p><p><strong>Results: </strong>Thirteen studies comprising 16 252 patients (RATS, n = 2427; VATS, n = 13 825) were included. There was no significant difference in PAL between RATS and VATS (RR, 1.01; 95% CI, 0.75-1.37; p = 0.93). Moderate heterogeneity was observed (I² = 44%). No evidence of publication bias was identified (Egger's test; intercept -0.54; 95% CI, -1.74 to 0.67; p = 0.41). Secondary outcomes were largely comparable, although length of stay was modestly shorter following RATS.</p><p><strong>Discussion: </strong>In this lobectomy-restricted analysis, surgical platform was not associated with differences in persistent air leak. These findings suggest that PAL is primarily driven by patient- and technique-related factors rather than operative platform. Restriction to lobectomy improves comparability relative to prior studies. However, incomplete baseline reporting and observational design limit causal inference.</p><p><strong>Conclusions: </strong>In lobectomy-only cohorts, RATS and VATS are associated with comparable rates of persistent air leak. Surgical platform alone does not appear to independently influence this outcome.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966482","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}