ANZ Journal of Surgery最新文献

{"title":"Defining Resectability in Retroperitoneal Sarcoma: The Difficulty in Standardising Judgement in Complex Surgical Oncology.","authors":"Emily Smartt, Kilian G M Brown, David J Coker","doi":"10.1111/ans.70312","DOIUrl":"https://doi.org/10.1111/ans.70312","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"25, 50 and 75 Years Ago","authors":"Julian A. Smith","doi":"10.1111/ans.70303","DOIUrl":"10.1111/ans.70303","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 9","pages":"1946-1947"},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940091","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":"Utility of Single Transhiatal Chest Drainage After Minimally Invasive Esophagectomy: A Propensity-Score Matched Study of Safety and Feasibility.","authors":"Da Wei Thong, Shabnam Islam, Ashok Gunawardene, Sanjeeva Kariyawsam","doi":"10.1111/ans.70301","DOIUrl":"https://doi.org/10.1111/ans.70301","url":null,"abstract":"<p><strong>Background: </strong>The routine placement of intercostal chest drains remains common practice following minimally invasive esophagectomy (MIO). Intercostal chest drains may contribute to increased postoperative pain and morbidity. This study compared outcomes between transhiatal and intercostal chest drain placement following MIO, focusing on analgesia use, hospital length of stay, and postoperative pulmonary complications.</p><p><strong>Methods: </strong>This was a retrospective case-control study of patients undergoing elective MIO at a quaternary center in Western Australia between September 2016 and September 2023. Propensity score matching was used to minimize confounding. All patients were identified from a prospectively maintained database. Patients undergoing MIO with exclusive transhiatal drainage, a 19 French Blake's drain was advanced through the hiatus into the right pleural cavity and positioned adjacent to the anastomosis.</p><p><strong>Results: </strong>Thirty patients were included in the study, 15 of whom had exclusively transhiatal drain placement. Mean total daily oral morphine dose equivalent was significantly lower in the transhiatal drain group (58 ± 35.8 mg) compared with the intercostal drain group (100.8 ± 64.0 mg) on postoperative Day 1 (p = 0.04). No significant difference was observed in the reintervention rate (p = 1.00), length of stay (p = 0.78), or postoperative pulmonary complications (p = 1.00).</p><p><strong>Conclusion: </strong>Transhiatal drain placement following MIO was associated with reduced opioid requirements on postoperative Day 1 and demonstrated comparable pulmonary complications and length of stay to intercostal drainage. These findings suggest that transhiatal drainage may be a safe and feasible alternative; however, larger prospective studies are required to confirm these preliminary results.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940152","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":"Cost Effectiveness of a Multidisciplinary Perioperative Protocol for High-Risk Emergency Major Abdominal Surgery in a Regional Victorian Hospital.","authors":"Jason Douglas Cox, Ayooluwatomiwa I Oloruntoba, Kate Booth, Travis Murphy, Cameron Knott, Chun Hin Angus Lee","doi":"10.1111/ans.70299","DOIUrl":"https://doi.org/10.1111/ans.70299","url":null,"abstract":"<p><strong>Background: </strong>The Australian and New Zealand Emergency Laparotomy Audit (ANZELA) was implemented as standard-of-care for Emergency Major Abdominal Surgery (EMAS) at Bendigo Health in September 2021. All EMAS patients undergo routine preoperative risk assessment (RPRA) using the 'National Emergency Laparotomy Audit (NELA) Calculator.' Patients with NELA mortality risk estimates ≥ 10% are considered 'high-risk' and routinely referred to the Intensive Care Unit (ICU) for planned postoperative admission. This study aims to identify whether RPRA and routine ICU referral for high-risk EMAS patients is a cost-effective intervention that improves postoperative outcomes in a rural health service.</p><p><strong>Methods: </strong>This study is a retrospective audit of high-risk adult patients who underwent EMAS at Bendigo Health between September 2017 and August 2023. Postoperative outcomes and costs were compared before and after implementation of ANZELA. A cost-effectiveness analysis was subsequently conducted to estimate the additional cost required to improve postoperative outcomes and presented as incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>A total of 191 high-risk EMAS patients were identified. The mean postoperative cost of care was AUD$52 338.78, with no significant change post-ANZELA (p = 0.983). Post-ANZELA, there was a 15.3% reduction in the rate of planned ICU admissions (p = 0.026), a 10.9% reduction in the rate of unplanned returns to theatre (p = 0.045), and a 16.83% reduction in the rate of severe postoperative complications (p = 0.03). There was no significant change in postoperative mortality (p = 0.59).</p><p><strong>Conclusion: </strong>RPRA and routine ICU referral of high-risk EMAS improve perioperative outcomes without increasing cost-of-care. This protocol may therefore be a cost-effective tool to guide the perioperative care of EMAS patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940128","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":"Utilisation of MRI in Newly Diagnosed Prostate Cancer in Aotearoa New Zealand","authors":"Matthew McCall,&nbsp;Andrew McIntyre-Robinson,&nbsp;Eng Toh,&nbsp;Hamish Green,&nbsp;Joel Dunn,&nbsp;Jared White,&nbsp;Stephen Mark","doi":"10.1111/ans.70270","DOIUrl":"10.1111/ans.70270","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The burden of prostate cancer (PCa) continues to increase in New Zealand, and remains the only solid organ cancer diagnosed by non-targeted biopsy. International guidelines have changed, making MRI routine given the unequivocal evidence of increased diagnostic accuracy. In Aotearoa, MRI has not been standardised in the diagnostic pathway, and there is anecdotal evidence of geographical variation in its use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study aimed to examine the prevalence, trend, and health equity in the use of MRI prostate in the diagnosis of PCa, and investigate the effect of MRI on the accuracy in diagnosing clinically significant PCa in New Zealand. Data was obtained from the PCa Outcomes Registry New Zealand between January 2016 and June 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>13 983 men (1155 Māori) were included (mean age of 67.6). Men who were diagnosed in the private sector were 3.6 times (OR: 95% CI: 3.0, 4.5) more likely to receive pre-biopsy MRI compared to those diagnosed in the public system. In the non-Māori group, those living in urban areas were more likely to receive pre-biopsy MRI than those living in rural areas (<i>χ</i>² = 39.8; <i>p</i> &lt; 0.001). There was a strong pre-biopsy MRI scan effect on the odds of detecting low-risk and higher grade PCa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are clear inequities in the access to pre-biopsy MRI between the public and private sectors, and in between the regions in Aotearoa. We need to identify and overcome the barriers in implementing standardised access to this invaluable diagnostic resource.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"95 9","pages":"1896-1905"},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940145","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":"Torted Fibroid: A Cause of Acute Abdomen in Pregnancy.","authors":"Cameron Douglas, Alexander Owen, Mark Muhlmann","doi":"10.1111/ans.70304","DOIUrl":"https://doi.org/10.1111/ans.70304","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940162","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":"Timing for a Surgically Safe and Oncologically Prompt Pancreatoduodenectomy After Preoperative Biliary Drainage in Patients With Bile Duct Cancer.","authors":"Tirayut Veerasathian, Schawanya Kaewpitoon Rattanapitoon, Nathkapach Kaewpitoon Rattanapitoon","doi":"10.1111/ans.70307","DOIUrl":"https://doi.org/10.1111/ans.70307","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940125","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":"Analgesia for Thoracic Surgery: Does Intraoperative Methadone Deserve a Place?","authors":"Eugene Constantine Lai, William Thomas Birkett, Luxmana Jeganathan, Ashley St John, Anurag Vijay, Walston Reginald Martis","doi":"10.1111/ans.70306","DOIUrl":"https://doi.org/10.1111/ans.70306","url":null,"abstract":"<p><p>Intraoperative methadone: potential benefits and considerations for thoracic surgery analgesia.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940089","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":"Genitourinary Outcomes in Patients Undergoing Pelvic Exenteration in an Australian Quaternary Centre.","authors":"Jordan Santucci, Haidar Al Saffar, Niranjan Sathianathen, Michael Bozin, Jacob MacCormick, Helen Mohan, Satish Warier, Declan Murphy, Alexander Heriot, Brian Kelly, Marlon Perera, Nathan Lawrentschuk","doi":"10.1111/ans.70279","DOIUrl":"https://doi.org/10.1111/ans.70279","url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenteration (PE) including en-block resection of two or more adjacent pelvic organs, regional lymph nodes, and pelvic side wall is a major surgical undertaking with associated morbidity. This study aims to assess the rate of urological intervention and complications of PE at an Australian quaternary centre.</p><p><strong>Methods: </strong>Patients undergoing PE with a genitourinary component between January 2003 and July 2021 were included. Data were collected prospectively and analyzed retrospectively. Complications were defined as early (< 30 days) or late (≥ 30 days) using the Clavien-Dindo classification.</p><p><strong>Results: </strong>A total of 424 patients underwent PE, of whom 213 (50.2%) had a genitourinary component. Early post-operative (30-day) mortality was 0.5% and overall survival was 59.6%. Early urological complications occurred in 106 (49.8%) patients, with 11 (5.2%) experiencing an early urine leak and five (2.3%) sustaining ureteric injury. A late urological complication eventuated in 56 (26.3%) patients, with 19 (8.9%) patients developing non-malignant ureteric stricture requiring upper tract intervention. Chronic kidney disease developed post-operatively in 39 (18.3%) patients at the completion of patient follow-up. Female sex and primary (versus recurrent) malignancy were the only statistically significant predictors of new chronic renal impairment (OR [95% CI] 2.86 (1.33-6.16) and 2.18 (1.09-4.34), respectively). No pre-operative clinicopathological factors predicted urine leak.</p><p><strong>Conclusions: </strong>Our experience with PE over a long follow-up period demonstrates urological complication rates consistent with the literature associated with urinary diversion and anastomosis, with expected rates of urine leak and ureteric stricture. Further research is required to better delineate and mitigate risk factors for genitourinary complications.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940175","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":"Why Are Patients Readmitted After Surgery for Gastric Cancer? Predictors of 30-Day Readmission Following Gastrectomy: A Single-Center Retrospective Cohort Study.","authors":"Tamir Lotan, Jossy Braun, Harel Jacoby, Yehonatan Nevo, Yuri Goldes","doi":"10.1111/ans.70302","DOIUrl":"https://doi.org/10.1111/ans.70302","url":null,"abstract":"<p><strong>Objective: </strong>Gastric cancer (GC) remains a major global health concern, with gastrectomy serving as the primary curative intervention. Early hospital readmission after gastrectomy is an important quality-of-care metric; however, data on its predictors and clinical implications remain limited. This study aimed to evaluate the incidence, timing, causes, and predictors of early readmission (within 30 days) after gastrectomy for GC.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study of patients who underwent gastrectomy for GC between January 2012 and January 2023. Patients with non-adenocarcinoma histology or cytoreductive/bariatric indications were excluded. The primary outcome was 30-day readmission, defined as inpatient hospitalization within 30 days of discharge. Univariable and multivariable logistic regression models were used to identify predictors of readmission.</p><p><strong>Results: </strong>Of 416 patients included, 103 (24.8%) presented to the emergency department (ED) within 30 days of discharge, and 72 (17.3%) were readmitted. The most common causes of readmission were intra-abdominal infections (26.4%), gastrointestinal symptoms (20.8%), and bleeding (12.5%). Readmitted patients had a significantly higher Charlson comorbidity index (median: 6 vs. 5, p = 0.002), more postoperative complications (54.2% vs. 38.7%, p = 0.018), and higher 90-day mortality (8.3% vs. 1.2%, p = 0.003). In multivariable analysis, a higher comorbidity burden and postoperative complications showed trends toward association with readmission but did not reach statistical significance.</p><p><strong>Conclusions: </strong>Thirty-day readmission after gastrectomy was associated with comorbidity burden and postoperative complications. Although these factors did not remain statistically significant in adjusted analyses, they may inform targeted discharge planning and early follow-up. Improved perioperative care and risk-based post-discharge interventions may reduce readmissions and improve outcomes in high-risk patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940094","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}