Surgery (RMH) - Research Publications

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    "Iodide mumps" after angioplasty
    Chuen, J ; Roberts, N ; Lovelock, M ; King, B ; Beiles, B ; Frydman, G (Elsevier, 2000-02-01)
    Vascular surgeons are increasingly performing endo- vascular fluoroscopy-guided procedures. We report a rare complication of radiographic contrast exposure (iodide-induced sialadenitis or “iodide mumps”), which has significance in the postoperative observation and management of patients after these procedures.
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    Real-world adjuvant chemotherapy treatment patterns and outcomes over time for resected stage II and III colorectal cancer
    To, YH ; Degeling, K ; McCoy, M ; Wong, R ; Jones, I ; Dunn, C ; Hong, W ; Loft, M ; Gibbs, P ; Tie, J (Wiley, 2023-06)
    BACKGROUND: The administration of adjuvant chemotherapy (AC) to colorectal cancer (CRC) patients in Australia and impact of recent trial data has not been well reported. We aim to evaluate temporal trends in AC treatment and outcomes in real-world Australian patients. METHODS: CRC patients were analyzed from 13 hospitals, stratified by stage (II or III) and three 5-year time periods (A: 2005-2009, B: 2010-2014, C: 2015-2019). Stage III was further stratified as pre- and post publication of the International Duration Evaluation of Adjuvant Therapy (IDEA) collaboration (March 2018). AC prescription, time-to-recurrence (TTR), and overall survival (OS) was compared across the time periods. RESULTS: Of 3977 identified patients, 1148 (stage II: 640, stage III: 508), 1525 (856 vs. 669), and 1304 (669 vs. 635) were diagnosed in Period A, B, and C, respectively. Fewer patients in Period C received AC compared to Period B in stage II (10% vs. 15%, p <.01) and III (70% vs. 79%, p <.01). Post-IDEA, the proportion of patients receiving ≤3 months of oxaliplatin-based AC increased (45% vs. 13%, p <.01). The proportion of patients who remained recurrence free at 3 years was similar between time periods in stage II (A: 89% vs. B: 88% vs. C: 90%, p = .53) and stage III (72% vs. 76% vs. 72%, p = .08). OS significantly improved for stage II (80%-85%, p = .04) and stage III (69%-77%, <.01) from period A to B. CONCLUSION: AC use has moderately decreased over time with no impact on recurrence rates. Improved survival in more recent years despite similar recurrence rates may be related to improved baseline staging, better postrecurrence treatment, and reduced noncancer-related mortality.
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    Case of the Month from Peter MacCallum Cancer Centre, Melbourne, Australia: ICG-assisted robotic Boari flap ureteric reimplantation in a case of missed ureteric injury
    Chen, K ; Lawrentschuk, N (Wiley, 2023-01)
    Itroductrion: Iatrogenic ureteric injuries are not uncommon, with reported incidences ranging from 0.5% to as high as 11.8% in some studies [1-3]. The mechanism of injury varies widely from intraluminal perforations resulting from endourology procedures to diathermy and ligation injuries in abdominopelvic operations [4, 5]. Regardless of aetiology, the management of iatrogenic ureteric injuries is challenging and requires various considerations to ensure optimal outcomes. In this BJUI Case of the Month, a patient with a missed ureteric injury following an emergency Hartmann's procedure is presented and discussed.
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    Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial
    Blazevski, A ; Geboers, B ; Scheltema, MJ ; Gondoputro, W ; Doan, P ; Katelaris, A ; Agrawal, S ; Baretto, D ; Matthews, J ; Haynes, A-M ; Delprado, W ; Shnier, R ; van den Bos, W ; Thompson, JE ; Lawrentschuk, N ; Stricker, PD (Wiley, 2023-06)
    OBJECTIVES: To prospectively assess the safety, functional- and oncological-outcomes of irreversible electroporation (IRE) as salvage therapy for radio-recurrent focal prostate cancer in a multicenter setting. PATIENTS AND METHODS: Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co-registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien-Dindo classification. Validated questionnaires were used for patient-reported functional outcomes. Follow-up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6-month mpMRI and standardised transperineal template mapping biopsies at 12-months. Thereafter follow-up was guided by MRI and/or PSMA-PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies. RESULTS: 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22-43) months. Median age was 71 (53-83), median PSA was 3.5 ng/mL (2.7-6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self-limiting urgency, frequency, or hematuria (grade 1-2). Seven patients (19%) developed a grade 3 AE; urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months. CONCLUSION: The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.
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    How prostate-specific membrane antigen positron emission tomography is refining risk calculators in the primary prostate diagnostic pathway
    Ptasznik, G ; Kelly, BD ; Murphy, D ; Lawrentschuk, N ; Kasivisvanathan, V ; Page, M ; Ong, S ; Moon, D (WILEY, 2023-09-10)
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    Synchronous vs independent reading of prostate-specific membrane antigen positron emission tomography (PSMA-PET) and magnetic resonance imaging (MRI) to improve diagnosis of prostate cancer
    Doan, P ; Counter, W ; Papa, N ; Sheehan-Dare, G ; Ho, B ; Lee, J ; Liu, V ; Thompson, JE ; Agrawal, S ; Roberts, MJ ; Buteau, J ; Hofman, MS ; Moon, D ; Lawrentschuk, N ; Murphy, D ; Stricker, PD ; Emmett, L (Wiley, 2023-05-01)
    Objectives: To identify whether synchronous reading of multiparametric magnetic resonance imaging (mpMRI) and 68Ga-PSMA-11 positron emission tomography (PET)/computed tomography (prostate-specific membrane antigen [PSMA-PET]) images can improve diagnostic performance and certainty compared with mpMRI/PSMA-PET reported independently and synthesized, while also assessing concordance between imaging modalities and agreement with histopathology. Methods: This was a retrospective analysis of 100 patients randomly selected from the PRIMARY trial, a prospective Phase II multicentre imaging trial. Three dual-trained radiologist/nuclear medicine physicians re-reported the mpMRI and PSMA-PET both independently and synchronously for the same patients in random order, blinded to previous results. Diagnostic performance was assessed for mpMRI/PSMA-PET images read synchronously or independently and then synthesized. Agreement between imaging results and histopathology was examined. ‘Concordance’ between imaging modalities was defined as overlapping lesions. Reporting certainty was evaluated by the individual reporters for each modality. Results: International Society of Urological Pathology Grade Group ≥2 cancer was present in 60% of patients on biopsy. Synchronous reading of mpMRI/PSMA-PET increased sensitivity compared to mpMRI or PSMA-PET alone (93% vs 80% vs 88%, respectively), although specificity was not improved (63% vs 58% vs 78%, respectively). No significant difference in diagnostic performance was noted between mpMRI/PSMA-PET read synchronously and mpMRI or PSMA-PET reported independently and then synthesized. Most patients had concordant imaging (60%), while others had discordant lesions only (28%) or a mixture (concordant and discordant lesions; 12%). When mpMRI/PSMA-PET findings were concordant and positive, 95% of patients had clinically significant prostate cancer (csPCa). When PSMA-PET alone was compared to synchronous PSMA-PET/MRI reads, there was an improvement in reader certainty in 20% of scans. Conclusion: Synchronous mpMRI/PSMA-PET reading improves reader certainty and sensitivity for csPCa compared to mpMRI or PSMA-PET alone. However, synthesizing the results of independently read PSMA-PET and mpMRI reports provided similar diagnostic performance to synchronous PSMA-PET/MRI reads. This may provide greater flexibility for urologists in terms of referral patterns, reducing healthcare system costs and improving efficiencies in prostate cancer diagnosis.
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    Sustainability in urology - are we doing enough?
    Lawrentschuk, N (Wiley, 2023-12-04)
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    Forecasting the future burden of primary total shoulder replacement in Australia
    Fisher, C ; Soh, S-E ; Page, RS ; de Steiger, R ; Cuthbert, AR ; Ackerman, IN (ELSEVIER SCI LTD, 2023-12)
    OBJECTIVE: To forecast the number of primary total shoulder replacements (TSR) in Australia to the year 2035, and associated costs. METHODS: De-identified TSR data for 2009-2019 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data, including population projections to 2035, were obtained from the Australian Bureau of Statistics. Three forecasting scenarios were used: constant TSR rates from 2019 onwards (Scenario 1, conservative); continued growth in TSR rates using negative binomial regression (Scenario 2, exponential); and continued growth using negative binomial regression with monotone B-splines (Scenario 3, moderate). Healthcare costs were estimated using TSR projections and average procedure costs, inflated to 2035 Australian dollars. RESULTS: The use of TSR increased by 242% in Australia from 2009 to 2019 (from 1983 to 6789 procedures for people ≥40 years). Under Scenario 1, the incidence of TSR is conservatively projected to rise to 9676 procedures by 2035 (43% increase from 2019), at a cost of $AUD 312.6 million to the health system. Under Scenario 2, TSR incidence would increase to 45,295 procedures by 2035 (567% increase), costing $AUD 1.46 billion. Under Scenario 3, 28,257 TSR procedures are forecast in 2035 (316% increase) at a cost of $913 million. CONCLUSIONS: Recent growth in TSR likely relates to prosthesis improvements, greater surgeon proficiency, and expanded clinical indications. Under moderate and exponential scenarios that consider rising TSR rates and population projections, Australia would face three- to five-fold growth in procedures by 2035. This would have profound implications for the healthcare budget, clinical workforce, and infrastructure.
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    The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms.
    Romanello, M ; Napoli, CD ; Green, C ; Kennard, H ; Lampard, P ; Scamman, D ; Walawender, M ; Ali, Z ; Ameli, N ; Ayeb-Karlsson, S ; Beggs, PJ ; Belesova, K ; Berrang Ford, L ; Bowen, K ; Cai, W ; Callaghan, M ; Campbell-Lendrum, D ; Chambers, J ; Cross, TJ ; van Daalen, KR ; Dalin, C ; Dasandi, N ; Dasgupta, S ; Davies, M ; Dominguez-Salas, P ; Dubrow, R ; Ebi, KL ; Eckelman, M ; Ekins, P ; Freyberg, C ; Gasparyan, O ; Gordon-Strachan, G ; Graham, H ; Gunther, SH ; Hamilton, I ; Hang, Y ; Hänninen, R ; Hartinger, S ; He, K ; Heidecke, J ; Hess, JJ ; Hsu, S-C ; Jamart, L ; Jankin, S ; Jay, O ; Kelman, I ; Kiesewetter, G ; Kinney, P ; Kniveton, D ; Kouznetsov, R ; Larosa, F ; Lee, JKW ; Lemke, B ; Liu, Y ; Liu, Z ; Lott, M ; Lotto Batista, M ; Lowe, R ; Odhiambo Sewe, M ; Martinez-Urtaza, J ; Maslin, M ; McAllister, L ; McMichael, C ; Mi, Z ; Milner, J ; Minor, K ; Minx, JC ; Mohajeri, N ; Momen, NC ; Moradi-Lakeh, M ; Morrissey, K ; Munzert, S ; Murray, KA ; Neville, T ; Nilsson, M ; Obradovich, N ; O'Hare, MB ; Oliveira, C ; Oreszczyn, T ; Otto, M ; Owfi, F ; Pearman, O ; Pega, F ; Pershing, A ; Rabbaniha, M ; Rickman, J ; Robinson, EJZ ; Rocklöv, J ; Salas, RN ; Semenza, JC ; Sherman, JD ; Shumake-Guillemot, J ; Silbert, G ; Sofiev, M ; Springmann, M ; Stowell, JD ; Tabatabaei, M ; Taylor, J ; Thompson, R ; Tonne, C ; Treskova, M ; Trinanes, JA ; Wagner, F ; Warnecke, L ; Whitcombe, H ; Winning, M ; Wyns, A ; Yglesias-González, M ; Zhang, S ; Zhang, Y ; Zhu, Q ; Gong, P ; Montgomery, H ; Costello, A (Elsevier BV, 2023-12-16)
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    Vascular endothelial growth factor d is dispensable for development of the lymphatic system
    Baldwin, ME ; Halford, MA ; Roufail, S ; Williams, RA ; Hibbs, ML ; Grail, D ; Kubo, H ; Stacker, SA ; Achen, MG (AMER SOC MICROBIOLOGY, 2005-03)
    Vascular endothelial growth factor receptor 3 (Vegfr-3) is a tyrosine kinase that is expressed on the lymphatic endothelium and that signals for the growth of the lymphatic vessels (lymphangiogenesis). Vegf-d, a secreted glycoprotein, is one of two known activating ligands for Vegfr-3, the other being Vegf-c. Vegf-d stimulates lymphangiogenesis in tissues and tumors; however, its role in embryonic development was previously unknown. Here we report the generation and analysis of mutant mice deficient for Vegf-d. Vegf-d-deficient mice were healthy and fertile, had normal body mass, and displayed no pathologic changes consistent with a defect in lymphatic function. The lungs, sites of strong Vegf-d gene expression during embryogenesis in wild-type mice, were normal in Vegf-d-deficient mice with respect to tissue mass and morphology, except that the abundance of the lymphatics adjacent to bronchioles was slightly reduced. Dye uptake experiments indicated that large lymphatics under the skin were present in normal locations and were functional. Smaller dermal lymphatics were similar in number, location, and function to those in wild-type controls. The lack of a profound lymphatic phenotype in Vegf-d-deficient mice suggests that Vegf-d does not play a major role in lymphatic development or that Vegf-c or another, as-yet-unknown activating Vegfr-3 ligand can compensate for Vegf-d during development.