ANZ Journal of Surgery最新文献

Background: To characterise the clinical, microbiological, radiological and operative features of Xanthogranulomatous Pyelonephritis (XGP) in a 10-year retrospective case series from the Top End of the Northern Territory (NT) of Australia.

Methods: We retrospectively reviewed all histopathologically confirmed XGP cases managed at Royal Darwin Hospital (2014-2024). Inclusion criteria were adults undergoing nephrectomy with a final histopathological diagnosis of XGP. Data included demographics, comorbidities, microbiology, imaging and surgical details. Descriptive analysis was performed.

Results: Ten cases were identified, 90% were female and 70% identified as Aboriginal and/or Torres Strait Islander. Mean age was 43.5 years overall, but lower among Aboriginal and/or Torres Strait Islander patients at 39 years. Most resided in remote or very remote areas. Recurrent urinary tract infections and staghorn calculi occurred in 80% of cases. Escherichia coli was the most isolated organism. Three patients experienced delays to care due to discharge against medical advice or loss to follow-up; two had encrusted ureteric stents in situ for over 5 years. All patients underwent nephrectomy; one laparoscopic case was converted to open. Three procedures were elective. All patients required postoperative ICU admission. No deaths occurred, although one patient developed necrotising fasciitis in the wound.

Conclusion: This first Australian case series of XGP highlights an overrepresentation of Aboriginal and/or Torres Strait Islander patients. Findings align with global patterns in presentation and management, but underscore regional challenges including delayed care, advanced disease and surgical complexity in the context of chronic health inequities. Culturally safe and community-informed strategies are essential to improve outcomes in this high-risk population.

Background: Postoperative pancreatic fistula (POPF) is the primary cause of morbidity after distal pancreatectomy (DP). This trial investigated the application of a combined polyethylene glycol (PEG) and recombinant human albumin sealant gel to the stapled, transected pancreatic margin to reduce clinically significant POPF.

Methods: A multicenter randomised controlled trial in patient candidates for DP with stapled transection was conducted. Participants were randomised to receive DP with or without PEG sealant applied to the stapled margin. The primary outcome was clinically significant POPF. Secondary outcomes included other complications, length of hospital stay and 90-day mortality.

Results: Seventy-eight patients with completed DP were included, 38 of whom underwent stapled DP combined with the use of PEG sealant (PEG group). No significant differences between the two groups were observed with respect to pathology type, operative approach or operative time. The PEG group exhibited significantly fewer complications (18% vs. 50% in the control group; p = 0.003), and a lower rate of POPF (11% vs. 28%; p = 0.08, respectively). Multivariate analysis revealed a significant association between spleen preservation and the rate of clinically significant fistula (OR 4.4; 95% CI 1.1-18.0; p = 0.038). The rate of POPF was lower in the PEG group but did not reach statistical significance (OR 0.3; 95% CI 0.1-1.2; p = 0.091).

Conclusion: Stapled DP combined with PEG application was associated with reduced complications. There was a lower rate of POPF in the PEG sealant group that did not reach statistical significance.

Australian new zealand clinical trials registry: ACTRN12620001336976p.

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.