Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short-term outcomes.

BACKGROUNDS: Robotic colorectal surgery is a method of performing complex surgery in a minimally invasive manner. In diverticular disease, chronic inflammation obscures tissues planes and increases difficulty of resection. This study aims to assess feasibility and safety of application of a robotic approach to diverticular disease, by reviewing short-term outcomes from a series of diverticular resections. METHODS: Forty-one patients underwent robotic colorectal surgery for diverticular disease across three centres within Melbourne from June 2016 to June 2022. Demographic, operative, and clinicopathological data were collected. Descriptive statistics were used to evaluate primary and secondary outcomes. Comparative analysis between simple and complex diverticular disease was performed to identify differences in groups regarding short term outcomes. The primary outcome in this study is to determine conversion rate from minimally invasive to open surgery. Secondary outcomes include major complication rates and length of stay. RESULTS: Of the 41 patients, 24 (58.5%) had simple disease, and 17 (41.5%) had complex disease. One patient (2.4%) required conversion to open resection. The median length of stay for complex disease was 7 days, for simple disease 5 days (P = 0.05). Four surgical Clavien-Dindo III or above complications occurred (9.8%), one patient required return to theatre. There were no anastomotic leaks or collections requiring radiological drainage. Thirteen patients (31.7%) underwent ureteric stenting and intraoperative indocyanine green dye ureteric identification. CONCLUSION: Robotic diverticular resections in this series are safe and associated with a low conversion rate of 2.4%. Robotic resection of complex disease was feasible with an acceptable safety profile.

Breast ultrasound in breast cancer surveillance; incremental cancers found at what cost?

PURPOSE: To determine the diagnostic parameters of breast ultrasound (US) in the setting of routine radiological surveillance after a diagnosis of breast cancer and evaluate costs of the inclusion of breast US as well as any survival benefit of US detected cases of recurrence in surveillance. METHODS: 622 patients underwent breast cancer surgery and follow up at Austin Health from July 2009 to December 2015. Retrospective data analysis was performed to determine; diagnostic parameters, financial costs of US and survival outcomes of US detected cases of recurrence. RESULTS: Patients underwent 1-9 years of breast cancer surveillance, with a median of 4.24 years. 390 (62.7%) patients underwent additional breast US surveillance to mammography. 232 (38.3%) fit criteria for use of additional breast US. 199 abnormal imaging episodes occurred, leading to 16 screen detected-cases of locoregional recurrence. US alone generated 107 abnormal images and found 9 cancers. US had a sensitivity of 44.1%, specificity of 95.2% and positive predictive value of 11.7% in comparison to mammography; 20.6%, 97.4% and 9.9% respectively. US had a biopsy rate of 4.0% and lead to an incremental cancer detection rate of 0.38%. The cost of incremental cancer found was $31,463.72 AUD. Survival outcomes based on method of detection of recurrence were insignificant (p value = 0.71). CONCLUSIONS: Breast US has a sensitivity of 44.1% and detected seven recurrences that were mammographically occult. Breast US has a similar PPV to mammography in surveillance. Breast US generated considerable biopsy rates and costs. Survival analysis was not able to detect any benefit of US detected cases of recurrence.

"First Do No Harm": Significance of Delays from Diagnosis to Surgery in Patients with Non-metastatic Breast Cancer.

BACKGROUND: The majority of patients with non-metastatic breast cancer will undergo surgery. This involves complex decisions that inevitably increase time from diagnosis to surgery beyond the currently recommended 30 days. This study aims to analyse factors that increase time to surgery and establish whether it is justifiable in the context of improved individualised breast cancer management. METHODS: A retrospective analysis of all patients at Austin Health surgically managed for non-metastatic invasive breast carcinoma between 2013 and 2019 was conducted. Time to surgery (TTS) was defined as time between informed diagnosis and cancer surgery. The patients were grouped into TTS groups of ≤30 days and >30 days. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of time interval between diagnosis and surgery. RESULTS: Seven hundred and thirty-one patients were included in our TTS analysis, only half of this cohort received surgery within the recommended 30 days. Many of the factors identified to be associated with increased TTS are the key to optimal management. Median follow-up for the cohort was 30 months. Between wait groups of ≤30 and >30 days, there were no significant association found between TTS and survival outcomes for DFS (HR 1.20 95% CI 0.56-2.60) and OS (HR 1.58 95% CI 0.82-3.03). CONCLUSION: Breast cancer management involves complex factors that significantly increase TTS. Surgery within 30 days of diagnosis is not associated with improved DFS and OS. Outcomes from this study support a revision of current recommendations for TTS in non-metastatic breast cancer care.