ANZ Journal of Surgery最新文献

Secondary lymphoedema remains an incurable long-term complication of breast cancer treatment. Prevention is our best chance against this debilitating condition. Strategies for selective de-escalation of oncological therapies have continued to evolve over the last few decades to reduce the incidence of this feared complication. In this manuscript we first review the current strategies in de-escalation of axillary treatment. We then review the current evidence for immediate lymphatic reconstruction in those high-risk patients who cannot be spared from more aggressive axillary management.

Background: The size, strength, and unpredictability of horses, makes any interaction a potential situation for minor to severe injury. Despite this, horses continue to be popular for work and recreational activities. There have been five recent Australian publications that have examined various aspects of horse-related trauma, but none have been conducted in regional New South Wales (NSW). This study aims to report on the pattern of horse-related trauma that met the Institute of Trauma Injury Management's (ITIM) Trauma Registry criteria for people who presented to the emergency department at a regional NSW hospital, Australia.

Methods: An analysis of horse-related trauma extracted from the Wagga Wagga Base Hospital's Trauma Registry from 2012 to 2023 was undertaken. Demographic and clinical variables were reported on all people (n = 85) and statistically evaluated.

Results: The cohort median age was 46 years (range 2-78). Males represented 51.8%. Fall from mounted position was the most common mechanism of injury (84.7%) followed by kick while unmounted (11.7%). The head (45.9%) and chest (32.9%) were the most common regions of injury with head (45.9%) and fractures (44.7%) the most common types of injury. 11.8% of people required ICU admission.

Conclusion: Horse-related trauma, whether a person is mounted or unmounted, causes mild to severe injuries and can require hospitalization. Horse-related trauma has the potential to significantly impact morbidity, result in death and must not be underestimated. Establishing a protocol for horse-related trauma presentations and increasing awareness of injury patterns sustained from this mechanism has the potential to improve diagnosis and reduce morbidity.

Background: Posterior retroperitoneoscopic adrenalectomy (PRA) for isolated adrenal metastasis is minimally invasive, may prolong survival and improve quality of life. The current evidence base is scant.

Methods: A multi-site retrospective analysis of all cases of PRA for adrenal metastasis between 2011 and 2023, by four high-volume adrenal surgeons was performed. Perioperative morbidity, disease-free and survival outcomes were reported.

Results: Of 51 patients, 34(67%) male, mean age 63 ± 12 years, mean BMI 28; 49 PRAs for adrenal metastatectomy were completed (one abandoned due to tumour unresectability, one conversion to anterior laparoscopic approach) across 11 hospitals (49% public). Primary tumours included: 11 colorectal, 11 renal, 8 lung, 6 hepatocellular, 4 sarcoma, 3 breast, 2 melanoma, 2 ovarian and 1 each of pancreatic, oesophageal, testicular and prostate cancer. There were 12 synchronous (<6 months) and 39 metachronous (>6 months after primary diagnosis) tumours; 21 (42%) left sided, none bilateral. Mean operative time was 95 ± 34 minutes, mean maximal tumour diameter was 34 mm ± 13 mm and median length of hospitalization 1 ± 1 days. There were 8 (16%) complications; 1 ICU admission, 1 re-admission for pneumonia and 6 Clavien-Dindo grade I complications. There were 10 (20%) mortalities and a median overall survival of 29 months (range 7-123, n = 41). Disease recurred in 15 (40%) patients (n = 37), with a median disease-free interval of 18 months (range 1-68). Port site recurrence occurred in 2 patients, both simultaneously with disseminated metastases.

Conclusion: In carefully selected patients with adrenal metastases, PRA by high-volume adrenal surgeons has minimal morbidity and short hospitalization. Surgery should be considered prior to local ablation.

Backgrounds: This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)-assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation.

Methods: Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot-assisted (n = 51) and laparoscopy-assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post-surgery.

Results: Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group.

Conclusion: No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes.

Purpose: We performed a systematic review and meta-analysis to assess the current evidence on the effectiveness of botulinum toxin A (BTX-A) intradetrusor injections in paediatric NB patients who are resistant to antimuscarinic treatments.

Methods: A study was carried out on PubMed, Medline, and Embase with the search terms: ('neurogenic bladder' OR 'myelomeningocele') AND 'toxin' AND ('children' OR 'paediatric'). The PICOS framework guided the search strategy and selection of studies in line with the PRISMA guidelines. Research involving original data that examined BTX-A in paediatric patients with NB was included. Studies were independently chosen and data were extracted by two reviewers.

Results: Nineteen studies (one randomized controlled trial, six prospective studies, and 12 retrospective studies) that investigated the clinical application of BTX-A injections in children with NB were identified. None of the studies compared BTX-A to a placebo, and most lacked a control group. Results showed that maximal cystometric capacity increased by an average of 97.7 mL (34.1-162% increase) (95% confidence interval [CI] 59.6 to 135.8), while maximal detrusor pressure decreased by 25.2 cm H₂O (95% CI -39.7 to -10.7). Bladder compliance improved by 5.3 mL/cm H₂O (95% CI 2.9 to 7.8). After treatment, the average incontinence resolution rate among patients was 73.4%. Urinary tract infections were reported by 77 patients (13.6%).

Conclusions: BTX-A administered intradetrusorally enhances cystometric capacity, compliance, and maximum neurogenic detrusor overactivity in paediatric patients suffering from neurogenic bladder. Nonetheless, this conclusion lacks support from studies with a high level of evidence.