ORCID Profile
0000-0001-8179-2182
Current Organisations
The University of Auckland
,
Royal Melbourne Hospital
,
Peter MacCallum Cancer Centre
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 28-12-2020
Publisher: Wiley
Date: 2022
DOI: 10.1111/ANS.17420
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.HPB.2018.07.015
Abstract: The left renal vein (LRV) may be used for venous reconstruction during hepato-pancreato-biliary (HPB) surgery, although concerns exist about compromising renal function. This study aimed to determine renal outcomes following LRV harvest during HPB resections. Circumferential PV/SMV resections from 2008 to 2014 were included within two groups (LRV harvest, Control). Absolute and change in Creatinine (Cr) and estimated GFR (eGFR), and rates of acute kidney injury (AKI) and chronic kidney disease (CKD), were compared. Multivariate logistic regression analyses were performed. 76 patients were included (LRV n = 17, Control n = 59). Median Cr and eGFR did not change within groups, although change in eGFR differed between groups at postoperative day (POD) 3 (-4.3 vs. 12.8, p = 0.0035) and 7 (-1.8 vs. 12.4, p = 0.0074). AKI occurred more frequently in the LRV group at POD1 (5/17 vs. 4/59, p = 0.023) and POD3 (5/17 vs. 3/59, p = 0012), with no difference in CKD between groups (2/11 vs. 5/33 at 3 months, p = 0.99). LRV harvest was an independent risk factor for AKI at POD1 and POD3, but not thereafter. Patients who undergo LRV harvest experience a higher rate of AKI in the first three post-operative days. LRV harvest during pancreas resection does not impact on long-term renal function.
Publisher: Wiley
Date: 22-03-2021
DOI: 10.1111/ANS.16730
Abstract: Readiness for practice is an ongoing concern in surgery. Surgeons who have completed general surgery training are expected to be proficient in performing common emergency procedures. The aim of this study was to assess the experience and autonomy of general surgery trainees in New Zealand in 10 emergency general surgery procedures, and identify factors associated with reaching primary operator (PO) thresholds. Operative logbook data from all New Zealand general surgery trainees from 2013 to 2017 were analysed. Data for 10 emergency general surgery procedures were extracted to determine PO and autonomous PO (mentor not scrubbed) rates. A threshold of 70% for PO and APO rates was used to define two levels of proficiency. A total of 120 trainees performed 40 865 included procedures. Trainees met the PO threshold for all procedures by Surgical Education and Training (SET) 5. The APO threshold was met for three of 10 procedures (appendicectomy, drainage of perianal abscess and perforated peptic ulcer repair). Final APO rates for the other procedures ranged from 18% to 58%. On multivariate analysis, SET year and case volume were associated with increased odds of meeting the PO and APO thresholds. Female trainees were less likely to reach the PO and APO thresholds for three of 10 and four of 10 procedures, respectively. Trainees had increasing PO and autonomous PO rates over the course of their training. Graduating New Zealand general surgeons likely have sufficient operative experience in emergency general surgery procedures. However, rates of autonomy are lower, and further research is needed to determine whether this affects readiness for independent practice.
Publisher: Wiley
Date: 17-05-2020
DOI: 10.1111/ANS.15885
Publisher: Wiley
Date: 10-2022
DOI: 10.1111/ANS.17941
Publisher: Springer Science and Business Media LLC
Date: 23-07-2020
Publisher: Elsevier
Date: 2012
Publisher: Wiley
Date: 27-02-2020
DOI: 10.1111/ANS.15768
Publisher: Oxford University Press (OUP)
Date: 21-10-2009
DOI: 10.1002/BJS.6862
Abstract: Although the benefits of enteral nutrition in acute pancreatitis are well established, the optimal composition of enteral feeding is largely unknown. The aim of the study was to compare the tolerance and safety of enteral nutrition formulations in patients with acute pancreatitis. Electronic databases (Scopus, MEDLINE, Cochrane Controlled Clinical Trials Register) and the proceedings of major pancreatology conferences were searched. Twenty randomized controlled trials, including 1070 patients, met the inclusion criteria. None of the following was associated with a significant difference in feeding intolerance: the use of (semi)elemental versus polymeric formulation (relative risk (RR) 0·62 (95 per cent confidence interval (c.i.) 0·10 to 3·97) P = 0·611) supplementation of enteral nutrition with probiotics (RR 0·69 (95 per cent c.i. 0·43 to 1·09) P = 0·110) or immunonutrition (RR 1·60 (95 per cent c.i. 0·31 to 8·29) P = 0·583). The risk of infectious complications and death did not differ significantly in any of the comparisons. The use of polymeric, compared with (semi)elemental, formulation does not lead to a significantly higher risk of feeding intolerance, infectious complications or death in patients with acute pancreatitis. Neither the supplementation of enteral nutrition with probiotics nor the use of immunonutrition significantly improves the clinical outcomes.
Publisher: PeerJ
Date: 24-03-2016
DOI: 10.7287/PEERJ.PREPRINTS.1893V1
Abstract: Background: Simtics Integrated Cognitive Simulator (ICS) is a software learning environment, previously demonstrated to be of use to surgical trainees in learning the cognitive aspects of procedural skills. It also includes a Test-Mode, which has not previously been assessed for its ability to discriminate between experienced and non-experienced operators. Methods: 10 experienced and 10 non-experienced participants performed a laparoscopic appendicectomy using the ICS laparoscopic appendicectomy (LA) module. Total score, total time, and four further metrics (incorrect hand, incorrect instrument, incorrect location, time 15s per step) were recorded for each in idual, across the four sections and nine steps of the simulation. Results: Median total score was greater amongst surgically experienced participants than surgically inexperienced participants (26.5 %, p = 0.023). Instrument use was a significant discriminator between these groups in 2 of 4 of the ICS LA sections.
Publisher: Oxford University Press (OUP)
Date: 13-04-2018
DOI: 10.1002/BJS.10832
Abstract: The aim of this systematic review and meta-analysis was to evaluate perioperative outcomes and survival in patients undergoing an artery-first approach to pancreatoduodenectomy in comparison with those having standard pancreatoduodenectomy. A systematic search of PubMed, MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed in accordance with PRISMA guidelines. Comparative studies including patients who underwent artery-first pancreatoduodenectomy and standard pancreatoduodenectomy were analysed. Seventeen studies were included in the final analysis. There were 16 retrospective cohort or case–control studies and one RCT. A total of 1472 patients were included in the meta-analysis, of whom 771 underwent artery-first pancreatoduodenectomy and 701 had standard pancreatoduodenectomy. Intraoperative blood loss (mean difference –389 ml P & 0·001) and the proportion of patients requiring intraoperative transfusion (10·6 per cent (54 of 508) versus 40·1 per cent (186 of 464) P & 0·001) were significantly lower in the artery-first group. Although rates of perioperative mortality were comparable between the two groups, perioperative morbidity (35·5 per cent (263 of 741) versus 44·3 per cent (277 of 625) P = 0·002), and the incidence of grade B/C pancreatic fistula (7·4 per cent (26 of 353) versus 12·8 per cent (42 of 327) P = 0·031) were significantly lower in the artery-first group. The R0 resection rate (75·8 per cent (269 of 355) versus 67·0 per cent (280 of 418) P & 0·001) and overall survival (hazard ratio 0·72, 95 per cent c.i. 0·60 to 0·87 P & 0·001) were significantly higher in the artery-first group. The artery-first approach to pancreatoduodenectomy may be associated with improved perioperative outcomes and survival.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.HPB.2019.11.002
Abstract: Uveal melanoma (UM) is a rare malignancy with a propensity for metastasis to the liver. Systemic chemotherapy is typically ineffective in these patients with liver metastases and overall survival is poor. There are no evidence-based guidelines for management of UM liver metastases. The aim of this study was to review the evidence for management of UM liver metastases. A systematic review of English literature publications was conducted across Ovid Medline, Ovid MEDLINE and Cochrane CENTRAL databases until April 2019. The primary outcome was overall survival, with disease free survival as a secondary outcome. 55 studies were included in the study, with 2446 patients treated overall. The majority of these studies were retrospective, with 17 of 55 including comparative data. Treatment modalities included surgery, isolated hepatic perfusion (IHP), hepatic artery infusion (HAI), transarterial chemoembolization (TACE), selective internal radiotherapy (SIRT) and Immunoembolization (IE). Survival varied greatly between treatments and between studies using the same treatments. Both surgery and liver-directed treatments were shown to have benefit in selected patients. Predominantly retrospective and uncontrolled studies suggest that surgery and locoregional techniques may prolong survival. Substantial variability in patient selection and study design makes comparison of data and formulation of recommendations challenging.
Publisher: Elsevier BV
Date: 05-2011
Publisher: Wiley
Date: 17-01-2012
DOI: 10.1111/J.1445-2197.2011.05992.X
Abstract: The demands of surgical training, learning and service delivery compete with the need to minimize fatigue and maintain an acceptable lifestyle. The optimal balance of working hours is uncertain. This study aimed to define the appropriate hours to meet these requirements according to trainees. All Australian and New Zealand surgical trainees were surveyed. Roster structures, weekly working hours and weekly 'sleep loss hours' (<8 per night) because of 24-h calls were defined. These work practices were then correlated with sufficiency of training time, time for study, fatigue and its impacts, and work-life balance preferences. Multivariate and univariate analyses were performed. The response rate was 55.3% with responders representative of the total trainee body. Trainees who worked median 60 h/week (interquartile range: 55-65) considered their work hours to be appropriate for 'technical' and 'non-technical' training needs compared with 55 h/week (interquartile range: 50-60) regarded as appropriate for study/research needs. Working ≥65 h/week, or accruing ≥5.5 weekly 'sleep loss hours', was associated with increased fatigue, reduced ability to study, more frequent dozing while driving and impaired concentration at work. Trainees who considered they had an appropriate work-life balance worked median 55 h/week. Approximately, 60 h/week proved an appropriate balance of working hours for surgical training, although study and lifestyle demands are better met at around 55 h/week. Sleep loss is an important determinant of fatigue and its impacts, and work hours should not be considered in isolation.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.PAN.2018.09.011
Abstract: Morphometric analysis of sarcopenia has garnered interest due to its putative role in predicting outcomes following surgery for a variety of pathologies, including resection for pancreatic disease. However, there are no standard recommendations on whether sarcopenia is a clinically relevant predictor of outcomes in this setting. The aim of this study was to review the prognostic impact of preoperatively diagnosed sarcopenia on postoperative outcomes following pancreatic resection. A systematic review of published literature was performed using PRISMA guidelines, and included a search of PubMed, MEDLINE and SCOPUS databases until May 2018. Thirteen studies, including 3608 patients, were included. There was a significant increase in the mean duration of post-operative hospital stay (mean difference of 0.73 days, CI: 0.06-1.40, P = 0.033), there was no difference in the postoperative outcomes, including: clinically relevant postoperative pancreatic fistula, delayed gastric emptying, post-operative bile leak, surgical site infection, significant morbidity and overall morbidity. Preoperative sarcopenia is associated with prolonged hospital stay after pancreatic surgery. However, sarcopenia does not appear to be a significant negative predictive factor in postoperative morbidity although study heterogeneity and risk of bias limit the strength of these conclusions.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Informa UK Limited
Date: 11-03-2023
Publisher: Wiley
Date: 11-2022
DOI: 10.1111/ANS.17873
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 12-2008
Publisher: Wiley
Date: 12-11-2014
DOI: 10.1111/ANS.12911
Publisher: Informa UK Limited
Date: 15-02-2021
Publisher: Springer Science and Business Media LLC
Date: 08-2008
DOI: 10.1007/S00268-008-9701-Y
Abstract: Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although there are no randomised trials to evaluate these techniques. The aims of this study were to review the scope and quality of recommendations in current clinical practice guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis and identify the degree of consensus between guidelines. A MEDLINE search was performed to identify current guidelines from any professional body published in the English language. Guidelines were analysed to determine their specific recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected pancreatic necrosis. Sixteen guidelines were reviewed. Percutaneous catheter drainage for pancreatic abscess was recommended by eight guidelines for infected pseudocysts, one guideline did not recommend its use and six recommended its use for infected necrosis, two guidelines did not recommend its use and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines for infected necrosis, endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations. Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst, and infected necrosis, and few recommendations were graded according to the strength of the evidence. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.HPB.2018.12.009
Abstract: Portal vein embolization (PVE) is used before major hepatectomy for hepatocellular carcinoma (HCC) to increase future liver remnant (FLR) volume. However, this may increase tumour growth rate, leading to more extensive resections. This study aimed to determine the effect of tumour growth, following PVE, on treatment plan. Retrospective cohort study conducted on patients treated from 2008 to 2015 with PVE before major hepatectomy for HCC. Liver and tumour volumetry was performed on pre- and post-PVE CT scans. Image-based and actioned plans were compared before and after PVE. Thirty-one patients received PVE. Non-tumour total liver volume decreased (median 1440 to 1394 cm Following PVE in the setting of HCC, tumour progression accounts for a change in treatment plan in approximately a quarter of patients. Further research is warranted to determine whether additional liver directed therapy should routinely be used to slow the growth of HCC post-PVE.
Publisher: Springer Science and Business Media LLC
Date: 03-09-2019
DOI: 10.1007/S11695-019-04161-3
Abstract: Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups. This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups. Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Māori had a similar NAFLD rate to non-Māori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Māori and Pasifika patients had similar referral rates to non-Māori and non-Pasifika [2/3 versus 5/9, p = 0.73 2/2 versus 5/10, p = 0.19]. Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.
Publisher: Wiley
Date: 2011
DOI: 10.1111/J.1445-2197.2010.05265.X
Abstract: Background: Minimally invasive techniques to manage infected pancreatic necrosis have been recently developed and changes in their pattern of use are unknown. The aims of this survey were to determine the trends in the role of minimally invasive techniques to manage infected complications of necrotizing pancreatitis and the barriers to performing minimally invasive necrosectomy in Australia and New Zealand. Methods: Members of the Australian and New Zealand Hepatic Pancreatic and Biliary Association were surveyed. Participant demographics and necrotizing pancreatitis caseload were determined. The perceived role of percutaneous catheter drainage and minimally invasive necrosectomy for pancreatic abscess, infected pseudocyst and infected pancreatic necrosis were scored on Likert scales, comparing 2002 with 2007. Barriers to performing minimally invasive necrosectomy were scored. Results: The response rate was 49% (44/90). Between 2002 and 2007, the role of percutaneous catheter drainage became more important as primary ( P = 0.05) and secondary ( P = 0.01) treatment for pancreatic abscess, and prior to minimally invasive necrosectomy for abscess, pseudocyst and necrosis ( P 0.01). Minimally invasive necrosectomy became increasingly important as primary treatment for infected necrosis ( P 0.01) and had been used by 47% of respondents. The greatest barriers to performing minimally invasive necrosectomy were lack of training and experience in the techniques, and the anatomical position and complexity of the target lesion. Conclusion: Minimally invasive techniques have an increasingly important perceived role in the management of pancreatic abscess, infected pseudocyst and infected pancreatic necrosis. Further evidence is required to determine the best techniques for treating each form of infection associated with necrotizing pancreatitis.
Publisher: American Physiological Society
Date: 11-2008
Abstract: Mesenteric lymph contributes to normal homeostasis and has an emerging role in the pathogenesis of multiple organ dysfunction syndrome. The aim of this study was to define the proteome of normal rodent mesenteric lymph in the fasted and fed states. Eight male Wistar rats fed a standard rodent diet were randomized to two groups. Group 1 (fasted, n = 4) were fasted for 24 h before anesthetized collection of mesenteric lymph. Group 2 (fed, n = 4) were allowed ad libitum access to food before lymph collection. Mesenteric lymph was subjected to proteomic analysis using iTRAQ and liquid chromatography-tandem mass spectrometry (LC-MS/MS). One hundred fifty proteins, including 26 hypothetical proteins, were identified in this study. All proteins were identified in lymph from both the fasted and fed states. The relative distribution profiles of protein functional classes in the mesenteric lymph differed significantly from that reported for plasma. The most abundant classes identified in lymph were protease inhibitors (16%) and proteins related to innate immunity (12%). In conclusion, this study provides the first detailed description of the normal mesenteric lymph proteome in the fed and fasted states using iTRAQ and LC-MS/MS.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2020
Publisher: Wiley
Date: 02-2018
DOI: 10.1002/JSO.24833
Abstract: Neoadjuvant chemoradiation and liver transplantation may be offered for unresectable perihilar cholangiocarcinoma (pCCA). This study aimed to determine the dropout rate and survival of patients who entered a national tri-modality protocol. Patients enrolled Jan 2009-Aug 2015 were included. Enrolment criteria: ≤65 years, brush biopsy-proven unresectable pCCA <3.5 cm diameter. Conformal radiotherapy was given concurrently with Capecitabine. Following surgical staging, patients received maintenance Cisplatin and Gemcitabine until transplant or progression. Time to event analyses were performed from start of neoadjuvant therapy. Of 43 patients screened, 18 started treatment median age 53.9 (26.7-62.8) years, tumour diameter 2.7 (2.0-3.4) cm. 11/18 dropped out due to metastatic disease identified during chemoradiation (n = 2), surgical staging (n = 6), or maintenance chemotherapy (n = 3). Six patients underwent transplantation. Median follow up was 17.6 (4.9-57.7) months and overall survival 16.4 months. One and two year survival was 70.6% and 35.3%, respectively. One and 2 year post transplant survival was 83.3% and 55.6%. Median progression free survival was 11.5 months. Neoadjuvant chemoradiation and liver transplantation for unresectable early stage pCCA is feasible, although with high rates of dropout and disease progression. Further research is required to determine factors to help select patients for treatment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
DOI: 10.1016/J.IJSU.2019.12.003
Abstract: Postoperative pancreatic fistula (POPF) remains a major cause of morbidity following pancreaticoduodenectomy (PD). This network meta-analysis (NMA) compared techniques of pancreatic anastomosis following PD to determine the technique with the best outcome profile. A systematic literature search was performed on the Scopus, EMBASE, Medline and Cochrane databases to identify RCTs employing the international study group of pancreatic fistula (ISGPF) definition of POPF. The primary outcome was clinically relevant POPF. Five techniques of pancreatic anastomosis following PD were directly compared in 15 RCTs comprising 2428 patients. Panreatojejunostomy (PJ) end-to-side invagination vs. PJ end-to-side duct-to-mucosa was the most frequent comparison (n = 7). Overall, 971 patients underwent PJ end-to-side duct-to-mucosa, 791 patients PJ end-to-side invagination, 505 patients pancreatogastrostomy (PG) end-to-side invagination, 98 patients PG end-to-side duct-to-mucosa, and 63 patients PJ end-to-side single layer. PG duct-to-mucosa was associated with the lowest rates of clinically relevant POPF, delayed gastric emptying, intra-abdominal abscess, all postoperative morbidity and postoperative mortality, the shortest operative time and postoperative hospital stay and the lowest volume of intra-operative blood loss. Duct-to-mucosa pancreaticogastrostomy was associated with the lowest rates of clinically relevant POPF and had the best outcome profile among all techniques of pancreatico-anastomosis following PD.
Publisher: Wiley
Date: 08-04-2022
DOI: 10.1111/ANS.17684
Publisher: Springer Science and Business Media LLC
Date: 07-05-2019
DOI: 10.1007/S12029-019-00248-3
Abstract: The prognostic significance of portal/superior mesenteric vein (PV/SMV) invasion at the time of pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) is contentious. The aim of this meta-analysis was to compare the survival outcomes in patients with histologically proven adventitial (superficial) versus media/intimal (deep) PV/SMV invasion at the time of PD for PDAC. A systematic search of the PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. All articles reporting outcomes specific to the depth of PDAC invasion into the PV/SMV wall were included. The primary outcome measure was overall survival. Six studies including 310 patients who underwent pancreatic resection with PV/SMV resection for PDAC were included in this meta-analysis. There was no difference in overall survival comparing superficial vs deep invasion at 12 months (64% vs 58% respectively, risk difference, - 0.09 CI, - 0.21-0.04 P = 0.183), 36 months (22% vs 18% respectively, risk difference, - 0.05 CI, - 0.16-0.19 P = 0.857) and mean overall survival (42.8 months vs 25.7 months respectively, standard mean difference, - 0.27 CI, - 0.58, 0.03 P = 0.078). Although larger tumours were seen in those with confirmed deep vein wall invasion (P < 0.001), no difference was observed between the superficial and deep invasion groups with regard to age (P = 0.298), R1 resection (P = 0.896), nodal metastatic disease (P = 0.120) and perineural invasion (P = 0.609). This meta-analysis suggests that the depth of PV/SMV wall invasion by PDAC may not impact survival after PD. However, given the limited s le size, further research is warranted with homogenous cohorts and longer follow-up.
Publisher: Wiley
Date: 12-10-2010
DOI: 10.1111/J.1445-2197.2010.05528.X
Abstract: The working hours of surgical trainees are a subject of international debate. Excessive working hours are fatiguing, and compromise performance, learning and work-life balance. However, reducing hours can impact on continuity of care, training experience and service provision. This study defines the current working hours of Australasian trainees, to inform the working hours debate in our regions. An online survey was conducted of all current Australasian trainees. Questions determined hours spent at work (AW) and off-site on-call (OC) per week, and roster structures were evaluated by training year, specialty and location. The response rate was 55.3%. Trainees averaged 61.4 ± 11.7 h/week AW, with 5% working ≥80 h. OC shifts were worked by 73.5%, for an average of 27.8 ± 14.3 h/week. Trainees of all levels worked similar hours (P= 0.10) however, neurosurgical trainees worked longer hours than most other specialties (P < 0.01). Tertiary centre rotations involved longer AW hours (P= 0.01) and rural rotations more OC (P 12 h) were worked by 86% median frequency 1:4.4 days median duration 15 h. OC shifts of 24-h duration were worked by 75% median frequency 1:4.2 days median sleep: 5-7 h/shift median uninterrupted sleep: 3-5 h/shift. This study has quantified the working hours and roster structures of Australasian surgical trainees. By international standards, Australasian trainee working hours are around average. However, some rosters demand long hours and/or induce chronic sleep loss, placing some trainees at risk of fatigue. Ongoing efforts are needed to promote safe rostering practices.
Publisher: Oxford University Press (OUP)
Date: 09-07-2009
DOI: 10.1002/BJS.6651
Abstract: There have been several reports of ischaemic complications after routine laparoscopy. The aim of this review was to investigate the relationship between this oxidative stress and pneumoperitoneum. Medline, Medline in-process, The Cochrane Library, PubMed and EMBASE were searched for papers on oxidative stress and pneumoperitoneum, from 1947 to March 2008 with no language restriction or restriction on trial design. Papers that did not investigate pneumoperitoneum as a causative factor, or did not report outcome measures related to oxidative stress, were excluded. A total of 73 relevant papers were identified: 36 animal studies, 21 human clinical trials, nine case reports, five review articles and two comments. Pneumoperitoneum causes a reduction in splanchnic blood flow, resulting in biochemical evidence of oxidative stress in a pressure- and time-dependent manner. There is evidence that the use of carbon dioxide for insufflation is contributory. Several measures proposed to minimize the oxidative stress have shown promise in animal studies, but few have been evaluated in the clinical setting. There is an increasing body of evidence, mainly from animal studies, that pneumoperitoneum decreases splanchnic perfusion with resulting oxidative stress. It is now appropriate to investigate the clinical significance of pneumoperitoneum-associated oxidative stress.
Publisher: The Royal Australian College of General Practitioners
Date: 12-2019
Publisher: Wiley
Date: 07-03-2021
DOI: 10.1111/ANS.16714
Abstract: Subspecialty surgery experience during general surgery training in Australasia is influenced by many factors, including duration of training, training location and the introduction of post‐fellowship training programmes. Experience in hepato‐pancreato‐biliary (HPB) and transplant surgery is part of the general surgery curriculum, although trainee experience in these subspecialties has not been quantified in this region, which is relevant to post‐fellowship training programmes. Therefore, the aim of this study was to quantify the HPB and transplant operative experience of New Zealand (NZ) general surgery trainees. Operative logbook data were analysed for all NZ trainees from 2013 to 2017, including procedures categorized as pancreatic, biliary, hepatic and transplant surgery only. The number of cases within each category was used to model the cumulative operative experience over a 5‐year training programme. During the study period, 118 trainees (303 trainee years) recorded 15 662 HPB and transplant procedures. Of these, 13 838 (88.4%) were cholecystectomies (mean cumulative experience 219.3 cases). Excluding cholecystectomy, trainees had a mean cumulative experience of 5.7 biliary, 7.5 pancreatic, 8.1 liver and 4.2 transplant procedures during their training. Transplant experience was predominantly access for peritoneal dialysis (228/260, 86.7%), with cumulative transplant experience otherwise reaching 0.47 procedures over 5 years. Exposure to HPB and transplant surgery during general surgery training in NZ is limited beyond cholecystectomy. Additional exposure during post‐fellowship training is likely required for general surgeons to practice in these subspecialties.
Publisher: Wiley
Date: 23-04-2021
DOI: 10.1111/ANS.16879
Abstract: To develop a model of clinical factors that may predict: (1) technically and clinically successful embolization of a bleeding vessel at digital subtraction angiography (DSA) for lower gastrointestinal bleed (LGIB) (2) a negative DSA in the presence of positive CT‐mesenteric angiography (CTMA) for LGIB. A retrospective cohort study of all DSAs conducted with intent for embolization for acute LGIB over a 10‐year period was undertaken. Pre‐procedural and intra‐procedural clinical variables were evaluated using uni‐ and multi‐variate analysis. One hundred and twenty‐three DSAs were evaluated. Technical success was 81% and clinical success 78% where DSA was positive. Technical success was associated with super‐selective approach, contrast extravasation on CT, haemoglobin drop, anatomical source and time from CT to DSA on univariate analysis. On multivariate analysis, time from CT to DSA was significant with a higher success probability within 120 min with different factors being salient depending on degree of delay. Clinical success was only associated with activated partial thromboplastin time ( .5 s). A negative DSA was associated with anatomical source, haemodynamic stability, platelet count and time from CT to DSA on univariate analysis. The latter three remained so on multivariate analysis. A triaging approach to utilizing emergency DSA may be helpful. If prolonged delay between CT and DSA is anticipated, with haemodynamic stability and a near‐normal platelet count, the DSA may not be fruitful. Technical success may be more likely if DSA occurs within 120 min. Clinical success may be more likely if activated partial thromboplastin time is within normal range.
Publisher: Oxford University Press (OUP)
Date: 04-12-2014
DOI: 10.1093/JSCR/RJU128
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.PAN.2019.03.002
Abstract: This systematic review aimed to define the outcomes of different pancreatic resection procedures for multiple endocrine neoplasia type 1 (MEN1) associated pancreatic neuroendocrine neoplasms (pNENs). A search of PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. Twenty-seven studies including 533 patients undergoing initial pancreatic resection for MEN1 associated pNENs were included in this systematic review. Three hundred and sixty-six (68.7%) distal pancreatectomies (DP), 120 (22.5%) sole enucleations (SE) and 47 (8.8%) pancreaticoduodenectomies (PD) were identified. SE was associated with a higher rate of recurrence than DP (25/67, 37% vs 40/190, 21% respectively, P = 0.008) but a lower rate of endocrine insufficiency than PD (1/20, 5% vs 8/21, 38% respectively, P = 0.010). A meta-analysis of major pancreatic resections (PD or DP) vs SE in 15 studies showed that SE is associated with an increased rate of recurrence (Major resection 42/184, 23% vs SE 20/53, 38% RR 0.65 CI 0.43-0.96 P = 0.032) but reduced rate of postoperative endocrine insufficiency (Resection 37/93, 40% vs SE 0/24, 0% RR 7.37 CI 1.57-34.64 P = 0.008). Similarly, insulinomas and functional pNENs overall had lower rates of recurrence and reoperation with major resection. There was no difference in the reoperation rates or survival outcomes after SE compared with major pancreatic resections at follow-up (pooled overall mean duration: 85 months). Major pancreatic resections for MEN1 associated pNENs have a lower risk of recurrence and a higher risk of postoperative endocrine insufficiency when compared to sole enucleation, but a similar rate of reoperation and survival.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-01-2021
DOI: 10.1097/DCR.0000000000002027
Abstract: Synchronous liver resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases have traditionally been contraindicated. More recent clinical practice has begun to promote this aggressive treatment in select patients. This study aimed to investigate the perioperative and oncological outcomes of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, with and without liver resection, in the management of metastatic colorectal cancer. Medline, Embase, and Cochrane Library databases were searched up to July 2020. Cohort studies comparing outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with and without liver resection for metastatic colorectal cancer were reviewed. No randomized controlled trials were available. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with or without synchronous liver resection were compared. The primary outcome measures were perioperative mortality and major morbidity. Secondary outcomes included 3- and 5-year overall survival and 1- and 3-year disease-free survival. Fourteen studies fitted the inclusion criteria, with 8 studies included in the meta-analysis. On pooled analysis, there was no significant difference in perioperative morbidity and mortality between the two groups. Patients that underwent concomitant liver resection had worse 1- and 3-year disease-free survival and 3- and 5-year overall survival. Only a limited number of studies were available, with a moderate degree of heterogeneity. The addition of synchronous liver resection to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of resectable metastatic colorectal cancer was not associated with increased perioperative major morbidity and mortality in comparison with cytoreduction and hyperthermic intraperitoneal chemotherapy alone. However, the presence of liver metastases was associated with inferior disease-free and overall survival. These data support the continued practice of liver resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy in the management of select patients with such stage IV disease.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
Publisher: Wiley
Date: 17-08-2018
DOI: 10.1111/ANS.14764
Abstract: This systematic review aimed to determine the accuracy of imaging modalities to predict resectability and R0 resection for borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC) after neoadjuvant therapy (NAT). A systematic search of major databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fifteen studies identified 995 patients of which 683 had BRPC and 312 LAPC. Computed tomography (CT) scan was the most common modality for re-staging (n = 14), followed by positron emission tomography (PET)-CT (n = 3) and endosonography (EUS) (n = 2). Stable disease on RECIST criteria was found in 67% of patients (range 53-80%) with 20% demonstrating reduction in tumour size. A total of 60% of patients underwent surgery post-NAT (range 31-85%) with a R0 rate of 88% (range 57-100%). Accuracy for predicting R0 resectability and T-stage on CT scan was 71 and 49%. A reduction in SUV More than half the patients undergo resection post-NAT for LAPC and BRPC. Stable, or reduction of, tumour disease may predict resectability. Reduction in tumour SUV
Publisher: American Medical Association (AMA)
Date: 11-2020
Publisher: Elsevier BV
Date: 06-2021
Publisher: Wiley
Date: 23-06-2010
DOI: 10.1111/J.1445-2197.2010.05349.X
Abstract: The Integrated Cognitive Simulator (ICS) is a software application that integrates text, anatomy, video and simulation for training clinical procedures. The aim of this randomized controlled trial was to determine the usability of the ICS laparoscopic appendectomy module, and to determine its effectiveness in training the cognitive skills required for the procedure. Junior surgical trainees were randomized into control and intervention groups. The latter had access to the ICS. Participants had three assessments: a pre-study questionnaire to determine demographics, 20 multiple choice questions to assess procedural knowledge (training effectiveness) after 2 weeks, and a questionnaire to assess usability after 4 months. Fifty-eight trainees were randomized. The overall response rate was 57%. The median scores for interface, functionality, usefulness and likelihood of utilization (usability) were 5/7 or higher. In the multiple choice questions (training effectiveness), first-year trainees in the intervention group scored higher than the control group (14.9 versus 12.1, P= 0.04), but second-year trainees did not. Use of the ICS did not alter the participants' perceived need for intra-operative guidance. The ICS is considered highly usable by trainees. The ICS is effective for training cognitive skills for laparoscopic appendectomy among first-year surgical trainees. Training cognitive skills alone does not increase confidence in the ability to perform motor tasks.
Publisher: BMJ
Date: 25-08-2020
DOI: 10.1136/BMJ.M2917
Abstract: To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. International, multicentre cohort study. 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. The cohort study included a representative s le of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative s le of 163 surgeons and anaesthetists from participating centres. Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42) grade II versus grade 0, 1.39 (0.97 to 2.00) grade III versus grade 0, 2.62 (1.31 to 5.26) and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. ClinicalTrials.gov NCT03009929 .
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.FREERADBIOMED.2009.08.019
Abstract: Sepsis and multiple organ dysfunction syndrome (MODS) are major causes of morbidity and mortality in the intensive care unit. Recently mitochondrial dysfunction has been proposed as a key early cellular event in critical illness. A growing body of experimental evidence suggests that mitochondrial therapies are effective in sepsis and MODS. The aim of this article is to undertake a systematic review of the current experimental evidence for the use of therapies for mitochondrial dysfunction during sepsis and MODS and to classify these mitochondrial therapies. A search of the MEDLINE and PubMed databases (1950 to July 2009) and a manual review of reference lists were conducted to find experimental studies containing data on the efficacy of mitochondrial therapies in sepsis and sepsis-related MODS. Fifty-one studies were included in this review. Five categories of mitochondrial therapies were defined-substrate provision, cofactor provision, mitochondrial antioxidants, mitochondrial reactive oxygen species scavengers, and membrane stabilizers. Administration of mitochondrial therapies during sepsis was associated with improvements in mitochondrial electron transport system function, oxidative phosphorylation, and ATP production and a reduction in cellular markers of oxidative stress. Amelioration of proinflammatory cytokines, caspase activation, and prevention of the membrane permeability transition were reported. Restoration of mitochondrial bioenergetics was associated with improvements in hemodynamic parameters, organ function, and overall survival. A substantial body of evidence from experimental studies at both the cellular and the organ level suggests a beneficial role for the administration of mitochondrial therapies in sepsis and MODS. We expect that mitochondrial therapies will have an increasingly important role in the management of sepsis and MODS. Clinical trials are now required.
Publisher: Wiley
Date: 17-05-2022
DOI: 10.1111/ANS.17770
Abstract: Post‐operative pancreatic fistula (POPF) is a key outcome post pancreaticoduodenectomy. There are numerous POPF risk calculators but no agreed benchmark, a key component of meaningful audit. We compared observed versus predicted POPF for six risk adjusted POPF calculators, to ascertain how they differ and thus contribute to discussion around benchmarking. This was a retrospective single‐arm cohort study at the Royal Melbourne Hospital of patients who underwent pancreaticoduodenectomy 1 November 2015 to 31 December 2021 with a primary outcome of a clinically relevant POPF. Cumulative sum (CUSUM) plots of observed versus predicted rate of POPF for sequential patients were constructed for six risk adjusted POPF calculators – Birmingham, updated Birmingham, fistula risk score (FRS), modified FRS (m‐FRS), alternative FRS (a‐FRS), and updated alternative FRS (ua‐FRS). The study included 77 patients. The actual rate of clinically relevant POPF was 14.3%. FRS calculated an excess of 1.3 POPF per 100 cases. All other calculators demonstrated prevention of POPF per 100 cases: Birmingham 3.4, updated Birmingham 14.0, m‐FRS 0.3, a‐FRS 1.2, ua‐FRS 19.7. The observed versus predicted rate of POPF was near zero for all risk calculators except ua‐FRS and updated Birmingham, which predicted a higher POPF than observed (19.7, 14.0, respectively). These results indicate that, excepting ua‐FRS and updated Birmingham, these calculators yield comparable results. Benchmarks for POPF should prescribe which risk calculators are used, and ideally a unified standard between centres should be the goal to provide consistency in outcome reporting and robust audit processes.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2007
DOI: 10.1007/S00268-007-9336-4
Abstract: Xanthine oxidase (XO) is a cytosolic metalloflavoprotein that has been implicated in the pathogenesis of a wide spectrum of diseases, and is thought to be the most important source of oxygen-free radicals and cell damage during re-oxygenation of hypoxic tissues. Clinical studies have already shown that XO inhibition is safe and effective for the treatment of gout, tumour-lysis syndrome, and to reduce complications such as post-operative arrhythmias, myocardial infarction and mortality in cardiovascular surgery. Here, we review the evidence from two decades of animal studies that have investigated the effects of XO inhibition during intra-abdominal surgery. A search of the Ovid MEDLINE database from 1950 through January 2007 was carried out using the following search terms: xanthine oxidase, allopurinol, ischemia, reperfusion, intestine, bowel, and general surgery. The inhibition of XO has been shown to reduce oxidative stress, neutrophil priming, damage to intestinal mucosa due to ischemia reperfusion injuries, intestinal anastomotic dehiscence, bacterial translocation, adhesion formation, distant organ injury and mortality. Despite this evidence which very strongly suggests a likely clinically beneficial role for XO inhibition in the elective and acute operative setting, it is surprising that such an approach has not been investigated in general surgery. There is now sufficient evidence to justify dedicated studies to determine the clinical benefits, dosing and duration of XO inhibition before and after gastrointestinal surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2001
DOI: 10.1097/00001665-200107000-00003
Abstract: Active counterpositioning and orthotic helmets are the two main nonsurgical management options for positional plagiocephaly. The purpose of this study was to compare these two management regimens. We included a random s le of infants referred between January 1, 1998 and October 31, 1999 to Middlemore Hospital and Auckland Surgical Center, for management of positional plagiocephaly. Two-dimensional head tracings were taken for each infant, every 3 to 12 months. From these tracings, we obtained Cranial Index and Cranial Vault Asymmetry Index. Seventy-nine infants were assessed during an average of 48.2 weeks. Five infants had normal head tracings, and were therefore excluded from the study. Of the 74 infants included in this study, 45 were managed with active counterpositioning, and 29 with orthotic helmets. Average management time for active counterpositioning was 63.7 weeks, and 21.9 weeks for orthotic helmet treatment. For infants managed with active counterpositioning, the average change in Cranial Vault Asymmetry Index was 1.9%. In the orthotic group, average change in Cranial Vault Asymmetry Index was 1.8%. Orthotic helmets have an outcome comparable to that of active counterpositioning, although the management period is approximately three times shorter. Active counterpositioning generally had a slightly better outcome than orthotic management after the management period.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.HPB.2018.10.004
Abstract: Stage 3 pancreatic ductal adenocarcinoma (PDAC) is defined by arterial involvement. This study objective was to evaluate outcomes for patients with stage 3 PDAC with potentially reconstructable arterial involvement, considered for neoadjuvant therapy (NAT) and pancreatic resection, and to compare outcomes following arterial (AR) and non-arterial resection (NAR). This study included patients from 2009 to 2016 with biopsy-proven stage 3 PDAC who were offered NAT before surgical exploration. AR was performed if required to achieve R0 resection. Time to event outcomes were analysed from diagnosis date. 87/89 patients (97.8%) received NAT (chemotherapy 41.6%, chemotherapy/radiotherapy 56.2%). 46/89 (51.7%) underwent exploration 31 underwent resection (AR n = 20, NAR n = 11). AR patients had longer operative time (681 vs. 563 min, p = 0.006) and more blood loss (1600 vs. 575 mL, p = 0.0004), with no difference for blood transfusion, pancreatic fistula, length of stay, reoperation, or mortality. R0 rate was 30/31. Post-resection 90-day mortality was 3.2%. Median overall survival was statistically comparable between the AR and NAR groups (19.7 vs. 28.4 months, p = 0.41). AR had comparable clinical and oncologic outcomes to NAR. Following careful selection and non-progression after NAT, major AR may cautiously be considered if required to obtain a negative resection margin.
Publisher: Wiley
Date: 26-05-2020
DOI: 10.1111/ANS.15912
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
DOI: 10.1038/AJG.2010.137
Abstract: Several clinical guidelines exist for acute pancreatitis, with varying recommendations. The aim of this study was to determine the quality of guidelines for acute pancreatitis. A literature search identified relevant guidelines, which were then reviewed to determine their document format and scope and the presence of endorsement by a professional body. The quality of guidelines was determined using the validated Grilli, Shaneyfelt, and AGREE instruments. Twenty-one of the 30 guidelines analyzed were endorsed by professional bodies. Median quality scores were as follows: Grilli, 2 Shaneyfelt, 13 and AGREE, 50. Guideline quality did not improve over time. Guidelines endorsed by a professional body had higher scores than those without official endorsement. Guidelines with tables, a recommendations summary, evidence grading, and audit goals had significantly higher scores than guidelines lacking those features. The many clinical guidelines for acute pancreatitis range widely in quality. Guidelines developed by professional bodies, and those with tables, a recommendations summary, evidence grading, and audit goals, are of higher quality. Further research is required to determine whether guideline quality alters clinical outcomes.
Publisher: Springer Science and Business Media LLC
Date: 14-05-2021
Publisher: Oxford University Press (OUP)
Date: 19-12-2011
DOI: 10.1002/BJS.7809
Abstract: Intraoperative cholangiography (IOC) is used to detect choledocholithiasis and identify or prevent bile duct injury. The aim of this study was systematically to review the randomized clinical trials of IOC for these two indications. MEDLINE, Embase, the Cochrane Library, clinicaltrials.gov and the World Health Organization database of clinical trials were searched systematically (January 1980 to February 2011) to identify trials. Two authors performed the literature search and extracted data independently. Primary endpoints were bile duct injury and retained common bile duct (CBD) stones diagnosed at any stage after surgery. Preliminary meta-analysis was undertaken, but the trials were too methodologically heterogeneous and the outcome events too infrequent to allow meaningful meta-analysis. Eight randomized trials were identified including 1715 patients. Six trials assessed the value of routine IOC in patients at low risk of choledocholithiasis. Two trials randomized all patients (including those at high risk) to routine or selective IOC. Two cases of major bile duct injury were reported, and 13 of retained CBD stones. No trial demonstrated a benefit in detecting CBD stones. IOC added a mean of 16 min to the total operating time. There is no robust evidence to support or abandon the use of IOC to prevent retained CBD stones or bile duct injury. Level 1 evidence for IOC is of poor to moderate quality. None of the trials, alone or in combination, was sufficiently powered to demonstrate a benefit of IOC. Further small trials cannot be recommended.
Publisher: Cold Spring Harbor Laboratory
Date: 05-2022
DOI: 10.1101/2022.04.29.489868
Abstract: The protective role of Natural Killer (NK) cell tumour immunosurveillance has long been recognised in colorectal cancer (CRC). However, as most patients show limited intra-tumoral NK cell infiltration, improving our ability to identify those with high NK cell activity might aid in dissecting the molecular features which could trigger strong response to NK cell-mediated immune killing. Here, a novel CRC-specific NK cell gene signature capable of inferring NK cell load in primary tissue s les was derived and validated in multiple patient CRC cohorts. The specificity of the signature is substantiated in tumour-infiltrating NK cells from primary CRC tumours at the single cell level, and the expression profile of each constituent gene is explored in NK cells of different maturation states, activation status and anatomical origin. Thus, in contrast with other NK cell gene signatures that have several overlapping genes across different immune cell types, our NK cell signature has been extensively refined to be specific for CRC-infiltrating NK cells and includes genes which identify a broad spectrum of NK cell subtypes. Moreover, it was shown that this novel NK cell signature accurately discriminates murine NK cells, demonstrating the potential applicability of this signature when mining datasets generated from both clinical and animal studies. Differential gene expression analysis revealed tumour-intrinsic features associated with NK cell inclusion versus exclusion in CRC patients, with those tumours with predicted high NK activity showing strong evidence of enhanced chemotactic and cytotoxic transcriptional programs. Furthermore, survival modelling indicated that NK signature expression is associated with improved survival outcomes in two large cohorts of primary CRC patients. Thus, scoring CRC s les with this refined NK cell signature might aid in identifying patients with high NK cell activity who could be prime candidates for NK cell directed immunotherapies.
Publisher: Elsevier BV
Date: 08-2021
DOI: 10.1016/J.HPB.2021.02.015
Abstract: Risk factors for the development of clinically relevant POPF (CR-POPF) following distal pancreatectomy (DP) need clarification particularly following the 2016 International Study Group of Pancreatic Fistula (ISGPF) definition. A systemic search of MEDLINE, Pubmed, Scopus, and EMBASE were conducted using the PRISMA framework. Studies were evaluated for risk factors for the development CR-POPF after DP using the 2016 ISGPF definition. Further subgroup analysis was undertaken on studies ≥10 patients in exposed and non-exposed subgroups. Forty-three studies with 8864 patients were included in the meta-analysis. The weighted rate of CR-POPF was 20.4% (95%-CI: 17.7-23.4%). Smoking (OR 1.29, 95%-CI: 1.08-1.53, p = 0.02) and open DP (OR 1.43, 95%-CI: 1.02-2.01, p = 0.04) were found to be significant risk factors of CR-POPF. Diabetes (OR 0.81, 95%-CI: 0.68-0.95, p = 0.02) was a significant protective factor against CR-POPF. Substantial heterogeneity was observed in the comparisons of pancreatic texture and body mass index. Seventeen risk factors achieved significance in a univariate or multivariate comparison as reported by in idual studies in the narrative synthesis, however, they remain difficult to interpret as statistically significant comparisons were not uniform. This meta-analysis found smoking and open DP to be risk factors and diabetes to be protective factor of CR-POPF in the era of 2016 ISGPF definition.
Publisher: SAGE Publications
Date: 31-01-2021
Abstract: Intracystic haemorrhage is a rare complication of hepatic cysts, and is often mistaken for a malignant lesion. A 55-year-old female with a history of polycystic kidney and liver disease presented with a six-month history of abdominal distension, abdominal pain, early satiety, shortness of breath and 5 kg of weight loss. Imaging revealed a 20 cm mixed solid-cystic hepatic lesion containing peripheral avascular mobile echogenic material with a flame-like morphology. After experiencing symptomatic relief from ultrasound-guided aspiration, the patient underwent cyst fenestration for more definitive treatment. Haemorrhagic hepatic cysts are uncommon and may present on imaging as having lace-like retractile clot, internal layering or shading of separating blood products or avascular mobile flame-like excrescences. The presence of avascular mobile flame-like excrescences appears to be a unique feature of haemorrhagic hepatic cysts. While haemorrhagic hepatic cysts are rare and commonly mistaken for biliary cystadenomas or adenocarcinomas, the identification of particular features on high-resolution magnetic resonance imaging and contrast-enhanced ultrasound can lead to the correct diagnosis.
No related grants have been discovered for Benjamin Loveday.