ANZ Journal of Surgery最新文献

Background: Acute pancreatitis (AP) is a catabolic disease with a risk of prolonged hospital stay. Patients are at risk of sarcopenia. However, the impact of sarcopenia on clinical outcomes post-AP is poorly explored.

Methods: A search of PUBMED, MEDLINE, and EMBASE databases was performed, and studies published between January 1990 and October 2024 were included.

Results: Ten studies with 2841 patients with a median age of 56.3 years were included. The number of patients with mild, moderate, and severe AP were 771, 545, and 399, respectively. Nine studies used skeletal muscle mass/skeletal muscle index/skeletal muscle attenuation, and one used visceral fat/muscle mass ratio as indicators of sarcopenia, measuring muscle mass at L3 vertebra or measuring psoas muscle volume. One longitudinal study reported that 80% of patients with severe AP were sarcopenic at 12 months. There was a strong correlation between sarcopenia and adverse clinical outcomes and mortality. There is no data on the impact of sarcopenia on quality of life (QOL).

Conclusion: This review suggests an association between sarcopenia and the severity of AP in addition to worse postpancreatitis outcomes. Further prospective studies are needed with standardized definitions for sarcopenia with longitudinal follow-up reporting on QOL.

Minimally invasive oesphagectomy has been found to reduce complications, length of stay and have improved post-operative quality of life compared to open oesophagectomy. Multiple techniques of the oesophagogastric anastomosis have been described in Australia including a three-stage approach with a neck anastomosis and a two-stage approach utilising the trans-orally placed anvil. We describe a two-stage approach with an intra-thoracic hand-sewn anastomosis for a junctional oesophageal cancer.

Background: Renal vein and caval tumour extension occurs in 10%-25% of patients with renal cell carcinoma. This study aims to examine perioperative morbidity and survival outcomes after radical nephrectomy with inferior vena cava tumour thrombectomy at a quaternary institution in Australia.

Methods: This was a retrospective review of nephrectomy with tumour thrombectomy cases between June 2012 and 2022 at a single centre, followed up until September 2024. Overall survival (OS) was visualised by Kaplan-Meier plots and comparisons between survival by presence of metastases, margin status, and thrombus level (I-III vs. IV) were explored with the log-rank test. Recurrence-free survival (RFS) in patients without initial metastases was also examined.

Results: We identified 39 patients, 25 (64%) were male and the median (IQR) age was 64 years (55-69). Metastatic disease was present in 14 patients (36%). Nineteen (49%) had level IV (supradiaphragmatic) tumour thrombus involvement. Six patients (15%) died in hospital, including two intraoperative deaths. A further 14 (36%) experienced Clavien-Dindo grade III or IV complications during their hospital stay. The median OS was 57 months (95% CI: 17-not reached). Excluding those who died in hospital, the median OS was 60 months (95% CI: 33-not reached). There was a significant difference in OS observed by the presence of metastatic disease (p = 0.003), but not with margin status (p = 0.35) or thrombus level (p = 0.22). The median RFS for M0 patients was 60 months (95% CI: 8-not reached).

Conclusion: While associated with high morbidity and mortality, nephrectomy and caval thrombectomy remain an effective treatment option for otherwise fatal advanced RCC.

Background: While studies have explored the gender gap in scientific literature, there is a scarcity of information on the impact within surgical publications. We examine the gender gap in Plastic and Reconstructive Surgery papers across two prominent Australasian journals.

Methods: All original clinical science articles published in AJOPS and ANZ Journal of Surgery were reviewed from 2018 to 2024. The gender of the first and last authors, as well as the subspecialty category, type of paper, journal volume, year and issue were entered in a database for further analysis. In addition, we examined whether first author gender was correlated to the gender of the senior faculty with whom they were co-authored.

Results: A total of 344 papers met the inclusion criteria for the study. Male authorship was more prevalent accounting for 65% in comparison to female authorship at 35%. When selecting for editorials only, male first authors accounted for 83% (43) versus female first authors at 17% (10). Excluding editorials, male first authorship reached 62% (183) while females made up the remaining 38% (108). In terms of senior authorship, males accounted for 80% (234) versus 20% (59).

Conclusion: Despite some fluctuation, our findings demonstrate a persistent disequilibrium in gender representation in the chosen journals which likely reflects the current disparity in the profession. Whether the increased recruitment and retention of female trainees and surgeons, is gradually translating to publication output, is not entirely understood. Further research is needed to identify and address the barriers to publication experienced by women in plastic surgery.

Background: Colorectal cancer liver metastasis (CRCLM) profoundly impacts the overall survival rates of affected individuals. Although chemotherapy remains a cornerstone of treatment, the variability in tumour response presents a considerable challenge to effective clinical management. Radiomics-based artificial intelligence (AI) modelling, utilising pre-treatment imaging, has been proposed as a tool to predict treatment response and inform therapeutic decision-making.

Methods: A systematic search using Clarivate (Web of Science) and Ovid (Embase and MEDLINE) from inception to April 8, 2025, was performed in accordance with Preferred Reporting Items for Reviews and Meta-Analysis (PRISMA) guidelines. Studies evaluating the use of AI radiomics models to predict CRCLM response to chemotherapy treatment, alone or in combination with targeted therapies were identified. Full-text review and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Checklist for Diagnostic Test Accuracy Studies.

Results: Thirteen studies met inclusion criteria. All studies described the development and validation of AI models with no implementation studies. The AI models developed demonstrated a varied ability to predict CRCLM response to chemotherapy. Predictive performance was classified as good in six studies and excellent in three. Model development used differing combinations of imaging modalities (CT or MRI), lesion inclusion criteria, dimensionality (2D vs. 3D), and use of clinical features. Most studies did not validate model performance in an external dataset.

Conclusion: Radiomics-based AI models show potential in predicting chemotherapy response in CRCLM. However, limited external validation and methodological variability currently restrict clinical applicability. Standardisation and prospective validation are required for clinical translation.

Background: Transanal opening of the intersphincteric space (TROPIS) has recently emerged as a sphincter-preserving option for the treatment of complex anal fistulas. Although high success rates have been reported in large international series, data on long-term real-world outcomes remain limited. This study aimed to evaluate long-term results of TROPIS, focusing on recurrence and continence, and to compare them with existing literature.

Methods: This retrospective single-center cohort included 28 patients who underwent the TROPIS procedure between 2020 and 2023. Demographic data, Parks classification of fistula, operative details, recurrence rates, healing times, and continence outcomes were analyzed. Recurrence was defined as the reappearance of fistula after initial complete healing. Continence was assessed using the Wexner score. Patients were followed with a mean follow-up of 680 ± 120 days.

Results: The mean age was 42.6 years. According to Parks' classification, 21 patients (75%) had transsphincteric, 5 (17.9%) extrasphincteric, and 2 (7.1%) complex transsphincteric (horseshoe variant). The average healing time was 36 days. No recurrence occurred within the first 90 days; thereafter, 9 patients (32.1%) developed recurrence (median 225 days, range 90-660). Early postoperative mild incontinence occurred in 42.9% of patients, but only 5 (17.8%) reported persistent mild symptoms at long-term follow-up. No major incontinence was recorded.

Conclusion: TROPIS appears to be a safe, sphincter-preserving technique for complex anal fistulas, providing acceptable healing with preserved continence. However, recurrence rates in this cohort were higher than those reported internationally, underscoring the need for careful patient selection, surgical expertise, and adequate long-term follow-up.

Background: The nasoseptal flap is commonly used in the reconstruction of the anterior skull base following sinonasal tumor resection, but has limitations in its use.

Methods: A retrospective case series at a quaternary referral center involved 13 consecutive anterior skull base resections reconstructed with a pericranial flap. Data collection included patient demographics, type of resection (endoscopic/open/combined), length of stay, follow-up and complications. The primary outcome was the cerebrospinal fluid (CSF) leakage rate and the secondary outcome was the overall complication rate.

Results: The median age was 64 years (range: 32-75 years), and median follow-up was 24.8 months. Four patients (30.8%) had prior radiotherapy, and 10 patients (76.9%) had adjuvant radiotherapy. Eight patients (61.5%) underwent pure endoscopic resection, while the remaining five (38.5%) had a combined endoscopic resection with an open approach required for an orbital exenteration. None of the patients had an open craniotomy. Post-operative CSF leakage was 7.7% (n = 1) and the overall complication rate was 23.1% (n = 3). In addition to the CSF leak, one patient (7.7%) experienced a tension pneumocephalus and another (7.7%) had a delayed presentation of an ascending intracranial infection.

Conclusions: The pericranial flap is a useful extranasal pedicled flap for reconstruction of the anterior skull base when the nasoseptal flap is not available or inadequate. Complications such as CSF leakage, tension pneumocephalus and ascending intracranial infections are uncommon, though they can be adequately managed when present.

Background: Total mesorectal excision (TsE) for rectal cancer is associated with significant morbidity. The 'Watch and Wait' approach, following a complete clinical response (cCR) to total neoadjuvant therapy (TNT), is increasingly considered as an alternative to surgery. The Internet offers extensive resources but the quality of these resources relating to 'Watch and Wait' is unknown. This study evaluates the availability and quality of online resources on 'Watch and Wait' as an option for patients with rectal cancer.

Methods: Using Google, search phrases: 'patient information watch and wait rectal cancer' and 'patient information non-operative management rectal cancer' were employed. The first 50 results of each search were assessed. Relevant sites meeting inclusion criteria were assessed using the DISCERN instrument, which evaluates the quality of published health information on treatment choices.

Results: Of 100 sites reviewed, three were duplicates. Fourteen sites provided dedicated patient-oriented information. Among non-dedicated sites, there were 63 scientific articles, 7 blogs, 6 resources for surgeons, 3 medical news articles, 2 videos, and 2 blocked sites. Of these 14 websites, 5 (35.7%) were updated within the last 2 years; 8 (57.1%) were associated with hospitals and clinics, and 6 (42.9%) with government or non-profit organizations. Most sites detailed the benefits of non-operative management, but 10 (71.4%) omitted uncertainties or risks. Only two (14.3%) were deemed 'high-quality' by DISCERN criteria.

Conclusion: Online patient resources on 'Watch and Wait' for rectal cancer are limited and often of poor quality. High-quality websites should be identified and recommended to patients wishing to seek further information on this topic.