Surgery (Austin & Northern Health) - Research Publications
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ItemRadical nephrectomy with caval tumor thrombectomy: An Australian experience(Canadian Urological Association, 2022)Introduction: Inferior vena cava (IVC) tumor thrombus is seen in up to 10% of renal cell carcinoma (RCC) and greatly complicates surgical management. We aimed to assess perioperative morbidity and longterm oncological outcomes after radical nephrectomy with caval tumor thrombectomy. Methods: This was a retrospective review of radical nephrectomy with caval tumor thrombectomy from 2011–2021. Continuous variables were reported as median (range). Kaplan-Meier survival curves were compared using the log-rank test. Results: We identified 22 patients; 15 (68.2%) were male and the median age was 63.5 years (34–75). There were three (13.6%) level III and eight (36.4%) level IV tumor thrombi. RCC size was 11.2 cm (2.7–21.0), with 13 (59.1%) right-sided. Nine (40.9%) patients had metastatic disease. Operative time was nine hours (5–18.8); seven (31.8) cases were performed emergently and nine (40.9%) underwent cardiopulmonary bypass. One (4.5%) patient died intraoperatively and four (18.2%) died in-hospital. Length of stay was 12.5 days (5–66) and 9 (40.9%) patients experienced Clavien-Dindo IV complications. Nineteen (86.4%) tumors were of clear-cell variant and 17 (77.3%) had positive margins. Excluding in-hospital deaths, median followup was 20 months (4–65). Five (27.8%) patients received adjuvant therapy and cancer recurrence occurred in six (33.3%). Overall survival (OS) was 66.7% (n=12) over a duration of 17 months (4–65) and recurrence-free survival (RFS) was 50% (n=9) over seven months (4–65). Time-to-recurrence and time-to-death were 9.5 months (2–19) and 13.5 months (1–33), respectively. On survival analysis, there were significant differences in OS (p=0.006) and RFS (p=0.006) with regards to metastatic status. Tumor thrombus level showed a difference in RFS only (p=0.006). Cardiopulmonary bypass was not predictive of OS (p=0.54) or RFS (p=0.82). Conclusions: Although radical nephrectomy with caval tumor thrombectomy is associated with significant morbidity and mortality, it remains an effective procedure in the treatment of advanced RCC.
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ItemTechnique and rationale for branch-first total aortic arch repair(ELSEVIER, 2020-12)OBJECTIVE: Our objective was to describe the technique and rationale for branch-first total aortic arch repair. METHODS: Branch-first total aortic arch repair involves serial clamping, reconstruction, and reperfusion of each of the arch branches using a specially designed trifurcation graft with a side port. During this sequence, perfusion to the heart and distal organs are preserved and continuous antegrade cerebral perfusion is permitted via the trifurcation graft. The diseased aorta is excised and replaced with a Dacron graft (W.L. Gore and Associates, Newark, Del) with a perfusion side port. The trifurcation graft is anastomosed to the new proximal ascending aorta. RESULTS: The branch-first technique permits total aortic arch repair without global cerebral circulatory arrest and excessive hypothermia. It shortens distal organ and cardiac ischemic time, and reduces the opportunity for air and particulate embolization during aortic repair. CONCLUSIONS: Branch-first total aortic arch repair allows continuous antegrade cerebral perfusion and shortens distal organ and cardiac ischemic time, with unobstructed access to the full extent of the diseased aortic arch.
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ItemNo Preview Available8th international conference: primary therapy of early breast cancer, St Gallen, Switzerland, March 12-15 2003.(Springer Science and Business Media LLC, 2003)The International St Gallen Breast Cancer Conference concentrates almost exclusively on adjuvant, multimodal primary therapy for early breast cancer. Begun 25 years ago, this meeting was initially held every 4 years, but therapeutic progress, new strategies and provocative trials data have accelerated to the extent that conferences are now held biennially. The meeting this year was attended by almost 3000 delegates. Major topics included new prognostic and predictive markers in early breast cancer, the best use of adjuvant chemotherapy and endocrine therapy, and innovations in local surgery and radiation therapy.
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ItemEvaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training.(Springer Science and Business Media LLC, 2004-11-21)BACKGROUND: The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. METHODS: The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. RESULTS: The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants. CONCLUSIONS: The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme - both trainers and trainees will be essential.
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ItemAnalysing Health Professionals' Learning Interactions in an Online Social Network: A Longitudinal Study(IOS PRESS, 2016)This paper summarises a longitudinal analysis of learning interactions occurring over three years among health professionals in an online social network. The study employs the techniques of Social Network Analysis (SNA) and statistical modeling to identify the changes in patterns of interaction over time and test associated structural network effects. SNA results indicate overall low participation in the network, although some participants became active over time and even led discussions. In particular, the analysis has shown that a change of lead contributor results in a change in learning interaction and network structure. The analysis of structural network effects demonstrates that the interaction dynamics slow down over time, indicating that interactions in the network are more stable. The health professionals may be reluctant to share knowledge and collaborate in groups but were interested in building personal learning networks or simply seeking information.