ORCID Profile
0000-0002-1574-3160
Current Organisations
Fiona Stanley Hospital
,
University of Sydney
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Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JSS.2018.09.026
Abstract: Colorectal cancer is a common and potentially deadly diagnosis. Surgery is the treatment of choice. Data of outcomes beyond 10 y are sparse. This study attempts to identify factors influencing long-term survival. This cohort study examines a prospectively collected database of patients undergoing colorectal resections from January 1996 to May 2006. Variables were analyzed by plotting Kaplan-Meier survival curves and Cox regression analysis to identify independent predictors of survival. Six hundred fifty-seven patients were included in this analysis. Three hundred sixty underwent resection for rectal cancer. Median follow-up time was 11.7 y (interquartile range 2.8-15.4). Metachronous cancers occurred following 5.4% (confidence intervals [CI] 3.4-8.4) of resections for colorectal malignancy at 15 y. Mean age at death was higher in patients with higher Australian clinicopathological score (A: 82.4, B: 78.9, C: 75.5, D: 68.9). Multivariable analysis revealed age at diagnosis (hazard ratio [HR] 1.02, CI 1.01-1.03), Australian clinicopathological score (B: HR 1.47, CI 1.08-2.01 C: 2.11, CI 1.51-2.93 D: HR 11.12, CI 8.12-15.13), American Society of Anesthesiology score (ASA2: HR 1.66, CI 1.03-2.67 ASA3: HR 2.00, CI 1.20-3.34 ASA4: HR 3.39, CI 1.95-6.25), and operating for locoregional recurrence (HR 1.82, CI 1.21-2.76) to be associated with increased mortality. Adjuvant chemotherapy was associated with improved survival (HR 0.64, CI 0.49-0.84). Age at diagnosis, American Society of Anesthesiology score, and stage of disease were the principal predictors of long-term survival. Adjuvant chemotherapy was found to improve survival. Metachronous cancers occurred in a minority of patients.
Publisher: Wiley
Date: 27-01-2018
DOI: 10.1111/ANS.14369
Abstract: Anastomotic dehiscence (AD) is the most feared complication following colonic and rectal anastomosis. Multiple attempts have been made to correlate the levels of biomarkers to the risk of AD. This study attempts to compare C-reactive protein (CRP), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) as predictors of AD. This case-controlled study collected data on patients undergoing colonic and rectal anastomosis over an 18-month period. Levels of CRP, PCT and NLR were recorded daily for the first 5 days post-operatively. These results were then compared between those who developed AD and those who did not. A total of 136 patients were included 11 (8.1%) patients developed AD. CRP and NLR were useful predictors of AD with an area under the curve of 0.81 and 0.78 on post-operative day 4. PCT was not found to be raised significantly higher in patients who developed AD compared to those who did not. CRP and NLR are useful predictors of AD. PCT is not a useful predictor of AD.
Publisher: Wiley
Date: 09-2018
DOI: 10.1111/ANS.14795
Publisher: Oxford University Press (OUP)
Date: 02-2023
DOI: 10.1093/JSCR/RJAD023
Abstract: Spontaneous haemoperitoneum (SH) is a rare but life-threatening condition with several well-recognized causes. SH often occurs in anticoagulated patients and requires urgent treatment to prevent mortality. SH is rarely associated with infective endocarditis (IE). To date, there are no reported cases of a haemorrhagic mesenteric abscess causing haemoperitoneum. We present the case of a warfarinized 30-year-old intravenous drug user with IE 2 weeks post-revision of a metallic valve who reported abdominal pain and subsequently suffered haemodynamic collapse. Abdominal computed tomography and damage-control laparotomy revealed haemoperitoneum secondary to an actively bleeding mesenteric nodule which was resected. Histopathology confirmed a haemorrhagic mesenteric abscess representing a rare sequela of IE and a novel cause of SH. Given that the incidence of IE appears to be increasing in people who inject drugs in Australia, the general surgeon should be aware of this clinical entity and the need for urgent intervention to prevent catastrophic sequelae.
No related grants have been discovered for Patrick Walker.