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1.
ANZ J Surg ; 94(4): 614-620, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38240147

RESUMO

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of care for selected cases of peritoneal surface malignancy. However, due to its morbidity and learning curve, it is only delivered in six centres in Australia and Aotearoa New Zealand (AoNZ). In this study, we report peri-operative morbidity and mortality following CRS/HIPEC at Waikato and Braemar Hospitals, which have treated patients from all regions of AoNZ since 2008. METHODS: We retrospectively reviewed a database of all patients undergoing CRS and HIPEC from 01/01/2008 to 01/11/2020 at Waikato and Braemar Hospitals. RESULTS: Two-hundred and forty procedures were performed for 221 patients with a mean age of 55, including 22 (9.2%) re-do procedures. One hundred and eighty-six cases were European, 32 were Maori, and 16 were Pasifika. There were 152 pseudomyxoma peritonei, 39 colorectal adenocarcinomas, 29 appendiceal cancers, 8 ovarian cancers, 6 peritoneal mesothelioma, and 6 other tumour types. The median PCI was 16. HIPEC was administered to 196 out of 196 CC0/1 cases (100%) and 3 out of 44 CC2/3 cases (6.8%). Fifty-six cases (23.3%) had at least one major complication. There were two mortalities (0.8%) within 30 days. The median length of stay was 11 days. Operative duration was identified as an independent risk factor for major complications. There was considerable variation in the number of referrals from different regions of AoNZ. Over time, a decline in major complication rate is seen with increased case volume. CONCLUSION: The Waikato region has achieved favourable short-term outcomes following CRS/HIPEC.


Assuntos
Procedimentos Cirúrgicos de Citorredução , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Peritoneais , Feminino , Humanos , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Nova Zelândia/epidemiologia , Neoplasias Peritoneais/patologia , Estudos Retrospectivos , Taxa de Sobrevida
2.
ANZ J Surg ; 94(4): 621-627, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37994292

RESUMO

BACKGROUNDS: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival for selected cases of peritoneal surface malignancy. In 2008, a CRS/HIPEC service was first established in Aotearoa New Zealand (AoNZ) at Waikato and Braemar Hospitals in the Waikato region. METHODS: This is a retrospective review of a prospectively maintained database of all patients undergoing CRS/HIPEC from 1 January 2008 to 1 November 2020 at Waikato and Braemar Hospitals. We analysed long-term survival and predictors of survival for each tumour type. RESULTS: 240 procedures were performed for 221 patients, including 22 re-do procedures. Cases had a median peritoneal cancer index of 16. Complete cytoreduction (CC0-1) was achieved in 196 cases (81.7%). All complete cytoreduction cases received HIPEC. There were 152 pseudomyxoma peritonei (PMP), 39 colorectal cancers (CRC), 29 appendiceal cancers, eight ovarian cancers, six peritoneal mesotheliomas, and six other cancers. The 5-year overall survival (OS) for PMP with acellular mucin, low-grade mucinous carcinoma peritonei, and high-grade mucinous carcinoma peritonei with or without signet cells were 91.6%, 80.5%, and 72.2%, respectively. 2- and 5-year OS in CRC were 56.7% and 40.4%. The achievement of complete cytoreduction improved the 5-year OS to 87.9% across all PMP and 45.1% in colorectal cancer. Incomplete cytoreduction predicted worse survival in appendiceal PMP. In colorectal cancer, worse survival was predicted in those who had incomplete cytoreduction, liver metastasis, and presentation with obstruction and perforation. CONCLUSION: Favourable long-term outcomes following CRS/HIPEC for peritoneal surface malignancy have been achieved in AoNZ through the Waikato peritonectomy service.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias do Apêndice , Neoplasias Colorretais , Hipertermia Induzida , Neoplasias Peritoneais , Pseudomixoma Peritoneal , Feminino , Humanos , Neoplasias Peritoneais/secundário , Quimioterapia Intraperitoneal Hipertérmica , Procedimentos Cirúrgicos de Citorredução/métodos , Nova Zelândia/epidemiologia , Hipertermia Induzida/métodos , Pseudomixoma Peritoneal/cirurgia , Neoplasias do Apêndice/patologia , Adenocarcinoma Mucinoso/patologia , Neoplasias Colorretais/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Terapia Combinada
3.
J Surg Case Rep ; 2020(3): rjaa018, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32161637

RESUMO

Bowel obstruction in pregnancy is a high risk situation for both the mother and baby. We present a case of a 30-week-pregnant woman who presented with abdominal pain and vomiting and was diagnosed with adhesive small bowel obstruction (SBO). Oral contrast media was successfully used as a treatment. The patient was discharged home and 10 weeks later delivered a healthy baby girl. We were unable to find any cases in the literature describing oral contrast media to treat adhesive SBO in pregnancy. From our experience and research, we consider oral contrast media as a method of treating adhesive SBO in pregnancy under the proviso that there are no signs that indicate urgent surgical intervention.

6.
ANZ J Surg ; 88(6): 592-596, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29205758

RESUMO

BACKGROUND: Transanal endoscopic microsurgery (TEMS) is a proven alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. It has proven benefits with lower morbidity and mortality compared with total mesorectal excision, and a lower local recurrence rate when compared to endoscopic mucosal techniques. METHODS: A retrospective data collection of TEMS procedures performed through Waikato District Health Board, New Zealand, from 2010 to 2015 was conducted. Supportive follow-up data were sourced from patient records and from local centres around New Zealand. RESULTS: A total of 137 procedures were performed over the study period, with five being repeat procedures. Procedures were mostly performed for benign lesions (66.4%) with an overall complication rate of 15.3%, only five of which were Clavien-Dindo grade III (3.6%). Our local recurrence rate after resection of benign lesions was 5.1%. CONCLUSION: Our data set demonstrates the TEMS procedure to be safe compared to radical resection (total mesorectal excision) for sessile rectal lesions. Close endoscopic follow-up is recommended, especially for close or incomplete margins. Good therapeutic results can be obtained for appropriately selected early malignant lesions. TEMS provides better oncological results than endoscopic mucosal resection or transanal excision.


Assuntos
Canal Anal/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Microcirurgia Endoscópica Transanal/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Nova Zelândia , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Microcirurgia Endoscópica Transanal/mortalidade , Resultado do Tratamento
7.
N Z Med J ; 130(1459): 33-42, 2017 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-28727692

RESUMO

AIM: Pseudomyxoma peritonei is a rare disease that affects 1-2 per million population per year. Treatment with cytoreductive surgery with heated intraperitoneal chemotherapy (CRS with IPC) has been well described. The purpose of this study was to look at the short-term outcomes following CRS with IPC for all such patients treated in Waikato. METHOD: Records for all patients presenting to surgery for CRS with IPC were retrospectively reviewed. CRS with IPC was performed in accordance with the techniques described by Sugarbaker. Data recorded included patient characteristics, characteristics of surgical treatment and early post-operative outcomes. RESULTS: Sixty-eight patients underwent 72 procedures. Fourteen patients were deemed unresectable at surgery and were treated palliatively. The median age was 57 with the majority being female (59%). The median time, from the decision made for surgery to CRS with IPC, was three months. The median prior surgical score was 1 and the median peritoneal cancer index (PCI) was 19.5. The median operating time was 9.08 hours (5.43-15.20). The majority of patients (76%) had pseudomyxoma peritonei, while the remainder had a combination of other appendiceal, colorectal, ovarian, gastric and primary mesothelial primaries. The major complication rate was 24% and the 30-day mortality rate was 1.4%. The median hospital stay was 12 days. CONCLUSION: Short-term outcomes following CRS with IPC at Waikato are comparable to those published in the literature. Further follow-up is anticipated for the publication of survival and recurrence data.


Assuntos
Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/terapia , Pseudomixoma Peritoneal/mortalidade , Pseudomixoma Peritoneal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Nova Zelândia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
BMC Infect Dis ; 17(1): 440, 2017 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-28633639

RESUMO

BACKGROUND: Fusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature. CASE PRESENTATION: A 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment. A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords "Fusobacterium" and "Liver abscess". Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre's Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks. CONCLUSION: Fusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.


Assuntos
Infecções por Fusobacterium/etiologia , Fusobacterium nucleatum/patogenicidade , Abscesso Hepático Piogênico/microbiologia , Infecções por Bacteroidaceae/etiologia , Drenagem , Feminino , Infecções por Fusobacterium/tratamento farmacológico , Infecções por Fusobacterium/microbiologia , Humanos , Abscesso Hepático Piogênico/tratamento farmacológico , Abscesso Hepático Piogênico/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/microbiologia , Prevotella/patogenicidade
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