ANZ Journal of Surgery最新文献

Background: Sessile serrated lesions (SSL) account for up to 30% of colorectal carcinoma pathogenesis. With multiple classification changes and improvements in colonoscopy equipment and technique, historical reporting may have underestimated the true incidence of SSLs. This study aimed to determine the incidence of SSLs in patients undergoing colonoscopic investigation in Canterbury, New Zealand over a 1-year period and describe their clinical and pathological characteristics.

Methods: Electronic records were searched to identify all lower endoscopy procedures with polypectomy performed from 1 January 2022 to 1 December 2022 (inclusive). Patients' electronic records were used to collect histological classification, location and size of each polyp removed during their procedure. The primary outcome was the number of procedures that had one or more SSL, adenoma or hyperplastic polyp identified. Secondary outcomes included histological classification, location and size of each polyp removed.

Results: There were 4346 procedures completed during the study period. Of these, 64.1% (2786) had a polypectomy and 18.6% (808) had at least one SSL excised. Individual polyp analysis was completed on 9166 polyps and found that 24.0% of polyps removed were SSLs and they were found predominately in the right colon (65.1% right colon, 32.6% left colon, 2.3% rectum). SSLs were typically <10 mm (84.8%).

Conclusion: This study found a higher incidence of SSLs compared to previous research. These results raise questions regarding whether SLL rates have been historically underestimated, whether SSL detection rate should be included as a key performance indicator and raises further concerns regarding the use of computed tomography colonography as a screening tool.

Background: Colorectal cancer (CRC) is the third most diagnosed cancer in the world, with an estimated 1.93 million cases diagnosed in 2020. While the overall CRC incidence in many countries is falling there has been a dramatic increase in CRC in those aged under 50 (early onset colorectal cancer, EOCRC). The reason for this increase in EOCRC is unknown. As the best predictor of survival is stage at diagnosis, early diagnosis is likely to be beneficial and population screening may facilitate this.

Methods: A narrative review of the literature was undertaken.

Results: Improving time to diagnosis in symptomatic patients is beneficial. However, by the time symptoms develop, over a third of patients already have metastatic disease. Screening asymptomatic patients (with Faecal Immunochemical test (FIT) and colonoscopy) has been proved to be effective in older patients (>60 years). In younger populations, the decreasing incidence rates of CRC previously made cost effectiveness, compliance and therefore benefit questionable. Now, with the increasing incidence of CRC in those under 50 years of age, modelling suggests screening with FIT and colonoscopy is cost effective from 40 years of age. There is evidence that some countries screening below 50 have prevented the rise in EOCRC incidence. Additionally the use of new and novel non-invasive biomarkers may also be able to improve the accuracy of screening asymptomatic patients.

Conclusion: Diagnosis of EOCRC once symptoms develop is often too late, and screening patients from age 40 is the best way to improve outcomes in this group.

Background: The demographics and geography of Australia and New Zealand (ANZ), with few metropolitan centres and vast, sparsely populated rural areas, represent a challenge to providing equal care to all patients. This study aimed to compare rectal cancer care at rural and urban hospitals in ANZ.

Methods: From the Bowel Cancer Outcomes Registry (BCOR, formerly known as the Bi-National Colorectal Cancer Audit; BCCA), rectal cancer patients treated between 2007 and 2020 were compared based on hospital location (urban versus rural). Propensity-score matching was performed to correct for differences in baseline characteristics between groups.

Results: A total of 9385 rectal cancer patients were identified from the BCOR: 1329 (14.2%) were treated at rural hospitals and 8056 (85.8%) at urban hospitals. Propensity-score matching resulted in 889 patients in each group, matched for age, ASA score, hospital type (public/private), tumour height from the anal verge, and pre-treatment cT- and cAJCC-stage. Rural patients had fewer pre-treatment MRIs (67.9% versus 74.7%; P = 0.002), and underwent less neoadjuvant therapy (44.7% versus 50.9%; P = 0.01). Rural patients underwent fewer ULARs (39.4% versus 45.6%; P = 0.03), and fewer anastomoses were formed (67.9% versus 74.4%; P = 0.05). CRM rates and postoperative AJCC stages (P = 0.19) were similar between groups (P = 0.87). Fewer rural patients received adjuvant chemotherapy (37.8% versus 43.3%; P = 0.02).

Conclusion: There are significant differences in pre-treatment MRI rates, (neo)adjuvant treatment rates and surgical procedures performed between rectal cancer patients treated at rural and urban hospitals in ANZ, while CRM rates and postoperative AJCC stages are similar.

Introduction: In this study, we investigated the clinical outcomes of patients who underwent surgery with proven lymph node metastasis.

Methods: Patients who were operated for lung cancer with pN1 or pN2 were examined in the study. The clinicopathological features and survival of the subjects were evaluated according to pN1-pN2 status, presence of neoadjuvant treatment, Positron emission tomography and computed tomography (PET/CT) avidity on mediastinal lymph nodes and specific lymph node stations.

Results: The study examines 100 patients operated from January 2016 to December 2021. Number of cases with pN1 and pN2 disease were 45 (45%) and 55 (55%) respectively. Thirty (30%) patients received neoadjuvant treatment. The 5-year overall survival (OS) and disease-free survival (DFS) of the patients were computed as 42.5% and 42.4% correspondingly. The 5-year cancer-related survival was 55.3%. In pN2 cohort, 5-year DFS was 67.9% in the neoadjuvant group and 15.9% in the non-neoadjuvant group (P = 0.042). In non-neoadjuvant group, 5-year DFS was 19.9% in cases with mediastinal PET/CT avidity and 56.3% in patients without mediastinal PET/CT avidity (P = 0.018). In pN2 disease, the presence of subcarinal or paratracheal lymph node metastasis did not create a significant difference in 5-year OS or DFS, but pulmonary ligament lymph node metastasis was found to be linked with worse survival in both 5-year OS (P = 0.005) and DFS (P = 0.017).

Conclusion: The main elements related with poor prognosis were absence of neoadjuvant treatment and pulmonary ligament lymph node metastasis in pN2 disease, detecting PET/CT avid mediastinal lymph nodes in non-neoadjuvant group.

Background: The World Health Organization (WHO) recommends simulation-based education (SBE) to acquire skills and accelerate learning. Literature focusing on SBE in the Pacific Islands is limited. The aim of this study was to determine Pacific Island healthcare workers' experiences, perspectives, and access to SBE.

Methods: This was a cross-sectional survey of Pacific Island healthcare workers. We designed an online questionnaire based on existing literature and expert consultation. The questionnaire included Likert scales, multiple-choice, multi-select and open-ended questions. Participants were healthcare workers recruited from professional networks across the region. Descriptive statistics and relative frequencies summarized data, and comparative testing included unpaired t-tests, Mann-Whitney U, Chi-squared and Fisher's exact tests. Free-text responses were presented to illustrate findings.

Results: Responses from 56 clinicians working in 11 Pacific Island countries were included. Fifty were medical doctors (89%), including 31 (55%) surgeons. Participants reported experience with scenario-based simulation (73%), mannequins (71%), and simulated patients (61%). Discrepancies were identified between previous simulation experience and current access for simulated patients (P = 0.002) and animal-based part-task trainers (P = 0.002). SBE was seen as beneficial for procedural skills, communication, decision-making and teamwork. Interest in further SBE was reported by most participants (96%). Barriers included equipment access (59%), clinical workload (45%) and COVID-19 restrictions (45%).

Conclusion: Some Pacific Island healthcare workers have experience with SBE, but their ongoing access is predominantly limited to low-technology modalities. Despite challenges, there is interest in SBE initiatives. These findings may inform planning for SBE in the Pacific Islands and may be considered prior to programme implementation.

Introduction: The rising prevalence of battery powered devices is driving a steady increase in lithium-ion battery-related burns. We present a case series of patients with lithium-ion battery-related burns and describe the clinical characteristics of this cohort. To further understand emerging trends, we compare our specialty inpatient case series with emergency department (ED) data collated by the Queensland Injury Surveillance Unit (QISU).

Methods: This is a retrospective case series of all patients admitted to the Professor Stuart Pegg Adult Burns Centre for burns relating to lithium-ion batteries between January 2014 and October 2023. In addition, we provide a retrospective data analysis of ED presentations for lithium-ion battery-related burns or blast injuries collated by the QISU.

Results: Within the case series data, the most common injuries caused by lithium-ion batteries leading to burn unit admissions were due to e-scooters (57.1%). Burns relating to e-scooter batteries were more likely to involve a larger total body surface area and to be deeper in nature, than burns due to other products. The most common ED presentations were from energy storage devices such as powerpacks (43%).

Conclusion: Lithium-ion battery-related burns are becoming more frequent. The majority of inpatient managed cases involved burns due to larger lithium-ion batteries used in e-scooters. This is the first Australian case series describing severe burns caused by this mechanism. Primary prevention through design, technological and behavioural strategies is required.