ANZ Journal of Surgery最新文献

Background: Advancements in the multidisciplinary management of locally advanced and recurrent rectal cancer, as well as advanced pelvic malignancies, have significantly improved oncological outcomes. Pelvic exenteration is a complex procedure involving en bloc resection of the involved organs with the aim of achieving a microscopic negative margin (R0)¹. Since 2012, the Royal Brisbane and Women's Hospital (RBWH) has been performing pelvic exenteration surgery and is now the statewide referral centre in Queensland. This study aims to present our oncological and surgical outcomes since establishment.

Methods: This is a retrospective cohort study utilising data collected from medical records of patients who underwent pelvic exenteration at the RBWH between 1 January 2012 and 31 August 2023. Ethics approval was obtained from the Metro North Hospital and Health Service Human Research Ethics Committee (HREC 102257).

Results: A total of 139 patients underwent pelvic exenteration surgery over the 11-year period. 117 of those were total exenteration, 22 were partial. The indications were locally advanced rectal cancer (56.8%), locally recurrent rectal cancer (22.3%), other primary or recurrent malignancy or benign, (10.8%, 7.9%, 2.2% respectively). The proportion of patients with an R0 resection was 90.4%. The overall survival (using Kaplan-Meier analysis) at 1, 2 and 5 years was 89.9%, 82.0%, and 62.9%, respectively. Disease-free survival at 1, 2 and 5 years was 76.1%, 67.0% and 59.2%. Disease-specific survival at 1, 2 and 5 years was 92.7%, 83.8% and 66.8%.

Conclusion: Our results were comparable to national data and PelvEx Collaborative group data and demonstrate that pelvic exenteration surgery can be safely performed in a lower volume centre with equivalent outcomes to higher volume centres.

Objective: To compare the clinical efficacy of the progressive suspension method and conventional thoracoscopic pulmonary resection in right upper lobectomy.

Methods: A prospective cohort study was conducted involving 60 patients admitted to the Department of Thoracic Surgery at Cangzhou Central Hospital from January 2024 to March 2025. Patients were randomly divided into the observation group (n = 30, using the progressive suspension method, including 15 cases of trans-thoracic puncture fixation and 15 cases of intra-thoracic suture fixation) and the control group (n = 30, conventional thoracoscopic pulmonary resection). Surgical field exposure, operative fluency, lymph node dissection, perioperative indicators, and hospitalization costs were compared between the two groups.

Results: The observation group demonstrated significantly superior surgical field exposure (83.3% vs. 50.0%, p = 0.008) and operative fluency (73.3% vs. 33.3%, p = 0.002). The operative time [(87.5 ± 23.2) min vs. (112.4 ± 35.6) min, p < 0.001], intraoperative blood loss [50 (20, 50) mL vs. 80 (50, 120) mL, p < 0.001], postoperative drainage [150 (100, 200) mL vs. 250 (180, 300) mL, p = 0.003], VAS pain score [(3.2 ± 1.1) vs. (4.8 ± 1.5), p < 0.001], and hospitalization costs [(4.5 ± 0.8) vs. (5.2 ± 1.1) ten thousand yuan, p = 0.009] were all significantly better in the observation group. The number of lymph nodes dissected [(10.3 ± 3.1) vs. (8.5 ± 2.8), p = 0.021] showed a statistically significant difference, while the complete lymph node resection rate (93.3% vs. 80.0%, p = 0.143) and complication rate (16.7% vs. 33.3%, p = 0.132) showed no significant difference. No statistical differences were observed between the two suspension subgroups (p > 0.05).

Conclusion: The progressive suspension method in thoracoscopic right upper lobectomy provides superior surgical field exposure, improved operative fluency, higher surgical efficiency, and better postoperative recovery compared to the conventional method, making it a safe and effective surgical approach.

Background: Achieving a margin-negative (R0) resection in borderline resectable pancreatic cancer (BRPC) is a critical prognostic determinant. The optimal clinical strategy-neoadjuvant therapy (NAT) versus upfront surgery (UFS)-remains a key clinical question.

Methods: This narrative review synthesized contemporary evidence from studies published between 2009 and 2025, encompassing a total of 5598 patients with BRPC. The analysis compared oncological outcomes between NAT and UFS, specifically focusing on resection rates, R0 resection frequency, and median overall survival (OS). Mixed-cohort studies lacking BRPC subgroup analysis were excluded.

Results: Evidence from both comparative and single-arm studies indicated that the majority of cohorts achieved significantly higher R0 resection rates and improved median OS following NAT. Resection rates after NAT ranged from 29% to 90%, whereas UFS cohorts reported rates between 62% and 92%. Although resection was more frequent in UFS groups, NAT cohorts demonstrated superior oncological margins; R0 rates in NAT groups ranged from 23% to 100% compared to 14% to 90% in UFS groups. This translated into a survival benefit, with NAT groups achieving a median OS of 11.0 to 43.9 months versus 11.6 to 27.8 months for UFS. NAT also facilitated superior pathological downstaging and reduced lymph node positivity.

Conclusion: Neoadjuvant therapy, utilizing potent multi-agent regimens, significantly improves R0 resection rates and overall survival in BRPC and is increasingly recognized as the preferred clinical strategy. Currently, this survival benefit is not clearly established for patients with upfront resectable disease.

Introduction: Surgical Site Infection (SSI) of an abdominal incision is a dreaded infectious complication following colorectal surgery. Understanding the intraoperative microbiology holds the key to prevention. Genomic sequencing has revolutionised culture-independent techniques, allowing for a more sensitive tool in microbial detection. The purpose of this study is to determine whether an aberrant microbiota is present within the intraoperative surgical site in patients that develop an SSI.

Methods: The subcutaneous abdominal surgical site of patients undergoing elective bowel resection was opportunistically sampled, following fascial closure. DNA was recovered from the swabs and used for 16S rRNA gene amplicon sequencing. The intraoperative microbiota was compared in those with and without a subsequent SSI with focus on alpha diversity and beta diversity, as well as taxonomic composition.

Results: 16/123 patients developed an SSI. The bacterial profile within the surgical site showed a strong presence of obligate anaerobes in all patients. Chao1, Shannon, and Simpson measures of alpha diversity from the intraoperative swabs were all significantly increased in SSI patients (p = 0.05, 0.05 and 0.05, respectively). Beta diversity demonstrated no significant separation between patients (Bray-Curtis dissimilarity index, PERMANOVA p = 0.394).

Conclusions: To the best of our knowledge this is the first study to demonstrate an aberrant intraoperative microbiota of the surgical site associated with subsequent infection. Pending validation studies, this provides a target for the strategic manipulation of the surgical site to reduce the burden of infection.

Background: In extensor pollicis longus ruptures not amenable to primary repair, secondary reconstruction of the tendon has traditionally been performed using either extensor indicis transposition or free tendon graft techniques. This paper constitutes a systematic review and meta-analysis of the current literature with a focus on Geldmacher's scoring to identify the effectiveness of these procedures.

Methods: We performed a literature search of medical databases to identify papers fulfilling the inclusion criteria. A meta-analysis abiding by Preferred Reporting Items of Systematic Reviews and Meta-analyses was completed with Geldmacher's score as a primary outcome and objective measurement of functional recovery following each procedure.

Results: Nine papers were identified and included in the meta-analysis following independent review by three researchers. On analysis of the data, "very good" and "good" Geldmacher's scores were achieved in 81.8% of patients who underwent extensor indicis transfer and 87.5% of patients who underwent tendon grafting. These results suggest that both techniques represent an equivalent return to postoperative function.

Conclusions: This systematic review and meta-analysis found that both extensor indicis transfer and tendon graft provide a practically equivalent return to function following extensor pollicis longus reconstruction. However, clinical limitations of tendon grafting, along with theoretical models of tendon repair may suggest extensor indicis as a more reliable means of reconstruction.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential therapeutic modality for the management of pancreatobiliary disease. Only two prior studies have reported ERCP outcomes in the rural Australian healthcare context. This study aimed to evaluate a 5-year experience of therapeutic ERCP for choledocholithiasis at a major rural referral centre in western New South Wales (NSW).

Methods: A retrospective cohort study was conducted including all patients who underwent ERCP for suspected choledocholithiasis at a rural NSW referral centre between January 2020 and January 2025. Data were collected on patient demographics, clinical presentation, procedural characteristics, cannulation failure and 30-day morbidity and mortality.

Results: Over the 5-year period, 1001 ERCP procedures were performed, of which 689 were for choledocholithiasis, treating 555 patients. Planned repeat ERCP for suspected incomplete duct clearance was required in 129 patients. Initial biliary cannulation failed in 11 patients, with successful repeat ERCP achieved in five within 72 h. Of the remaining six patients, one required percutaneous transhepatic cholangiography with anterograde stent placement, three had further intervention abandoned due to significant comorbidities and two were referred for SpyGlass cholangioscopy at a tertiary centre. Most procedures were performed emergently (81%) and 348 patients were transferred from peripheral hospitals. Median procedure time was 32 min and median length of stay was 2 days. ERCP-related complications occurred in 51 patients (9%), including post-ERCP pancreatitis (4%), post-sphincterotomy bleeding (3%), cholangitis (2%) and perforation (1%). Three ERCP-related deaths (0.4%) were recorded. Among emergency cases, median time to ERCP was shorter for local patients compared with transferred patients (1 vs. 4 days), with no difference in complication rates or 30-day mortality (p > 0.05).

Conclusions: This is one of the largest rural Australian ERCP series reported. Therapeutic ERCP for choledocholithiasis can be delivered safely and effectively in a rural setting, with outcomes comparable to tertiary centres.

Background: Predatory journals threaten academic integrity by exploiting open-access models for profit over scholarly quality. They employ aggressive solicitation tactics targeting vulnerable researchers. This study analyses 1 year of solicitation data to identify characteristic patterns and red flags, focusing on impact factor (IF) claims, indexing status and International Standard Serial Number (ISSN) presence, commonly used to create a facade of credibility.

Methods: A retrospective descriptive audit examined 422 email solicitations received by a single academic urologist between January 2023 and January 2024. Journals were identified as predatory based on Beall's list, the KSCIEN list, or multiple red flags. Data were extracted from journal websites and verified using PubMed, Journal Citation Reports (JCR) and SCImago. Descriptive analyses identified indicators associated with predatory practices.

Results: Over a12-month period, 422 emails were received from 196 unique journals representing 89 publishers. Ninety-four journals claimed IF, only two were verified by JCR and 14 by SCImago. Of these, 48 claimed IF < 2, 47 claimed IF ≥ 2, with the highest reported 6.705. Seven journals falsely claimed PubMed indexing, and 47 lacked an ISSN. Sixty-two journals listed addresses linked to unrelated businesses, 12 provided none and many used vague geographic identifiers. Concerningly, only 111 journals appeared on both Beall's and KSCIEN lists, while 51 were on neither despite clear predatory behaviour.

Conclusions: These findings reveal predatory journals' pervasive unethical practices, fake IFs, false indexing, misleading information, thus undermining scholarly publishing. These exploratory findings, highlight the importance of greater researcher vigilance and systemic action to safeguard research communication.