Bilateral Wilms' tumour: An international comparison of treatments and outcomes.

INTRODUCTION: Wilms' tumour is the most common childhood renal malignancy, with 5-10% of cases presenting bilaterally 1. However, there is currently no consensus between centres on optimal management of bilateral Wilms' tumours. This is an international multi-centre case series comparing management and outcomes of bilateral Wilms' tumours between low-income centres (LIC) and high-income centres (HIC). METHODS: Patients with bilateral Wilms' tumour were identified from four tertiary referral centres internationally. Data were collected on baseline characteristics, disease status, treatment used and clinical outcomes. Results were compared between individual centres as well as between groups of low-income centres (LIC) and high-income centres (HIC). RESULTS: Data were collected for forty patients. Most patients received preoperative chemotherapy (n = 38, 95%). The most common surgical procedures were bilateral nephron-sparing surgery (n = 10, 25%) and nephrectomy with partial nephrectomy (n = 20, 50%). Ten-year survival after treatment was as follows: LIC's n = 13 (65%); HIC's n = 20 (100%) (p = 0.01). DISCUSSION: Ten-year survival was significantly higher in HIC's. Our results show this may be caused by patient factors such as later presentation with more advanced disease in low-income centres. This comparative case series is the first to report on a large number of cases from multiple international centres, and to compare key outcomes.

Epidural Versus Transabdominal Wall Catheters: A Comparative Study of Outcomes After Pancreatic Resection.

BACKGROUND: This study compared epidural analgesia with local anesthetic administration via transabdominal wall catheters (TAWC), to determine the effect on perioperative outcomes in pancreatic surgery. MATERIALS AND METHODS: A retrospective review of patients undergoing open pancreatic surgery at Auckland City Hospital from 2015 to 2018 was undertaken. Data collected included patient demographics, type of perioperative analgesia, intravenous fluid and vasopressor use, length of high dependency unit stay, postoperative complications, and length of hospital stay. RESULTS: Seventy-two patients underwent pancreatic surgery, of which 47 had epidural analgesia and 25 TAWC. The median age was 64 y (range 29-85). Failure of analgesia method occurred in 45% of epidural patients and 28% of TAWC patients (P = 0.209). There was no significant difference in volume of intravenous fluid given or need for vasopressors in the first 3 postoperative days, length of high dependency unit stay (median 1 d, P = 0.2836), rates of postoperative pancreatic fistula (32% versus 40%, P = 0.6046), postoperative complications (38% versus 20%, P = 0.183), or mortality (0.04% versus 0.04%, P = 1.0). CONCLUSIONS: Epidural analgesia and TAWC may have comparable perioperative outcomes in patients undergoing pancreatic surgery. Further randomized studies with a larger cohort of patients are warranted to identify the best postoperative analgesic method in patients undergoing pancreatic resection.

Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials.

INTRODUCTION: Negative pressure wound therapy (NPWT) may prevent subcutaneous fluid accumulation in a closed wound and subsequently reduce surgical site infections (SSI). This meta-analysis aimed to determine the effect of prophylactic NPWT on SSI incidence following abdominal surgery. METHODS: A systematic search of MEDLINE and EMBASE databases was performed using PRISMA methodology. All randomised trials reporting the use of NPWT in closed abdominal incisions were included, regardless of the type of operation. The primary outcome measure was the incidence of SSI, stratified by superficial and deep and organ/space infections. Secondary outcomes were wound dehiscence and length of hospital stay. RESULTS: Ten randomised trials met the inclusion criteria (five Caesarean, five midline laparotomy). The use of NPWT reduced overall SSI (11.6% vs. 16.7%, RR 0.67, 95% CI 0.48-0.95, p = 0.02). The rate of superficial SSI rate was also reduced (6.3% vs. 11.3%, RR 0.57, 95% CI 0.35-0.94, p = 0.03). There was no effect on deep or organ/space SSI (3.2% vs. 4.2%, RR 0.77, 95% CI 0.51-1.18, p = 0.23), wound dehiscence (9.7% vs. 10.9%, RR 0.92, 95% CI 0.69-1.21, p = 0.54), or length of hospital stay (MD 0.06 days, 95% CI-0.11 to 0.23, p = 0.51). CONCLUSIONS: Prophylactic use of NPWT may reduce the incidence of superficial SSI in closed abdominal incisions but has no effect on deep or organ space SSI.

Is hook diathermy safe to dissect the mesoappendix in paediatric patients? A 10-year experience.

BACKGROUND: Laparoscopic appendicectomy is one of the most commonly performed abdominal surgical procedures in children, with many different techniques used to isolate and control the appendiceal artery. Previous studies have looked into the utility of different methods of mesoappendix dissection, however these have been predominantly small-scale studies performed on adults. AIM: The current study aimed to assess the safety and efficacy of 'hook' diathermy as a sole means of mesoappendix dissection in children under 15 years of age undergoing laparoscopic appendicectomy. METHODS: Retrospective review of hospital database and electronic clinical notes of children aged under 15 who underwent laparoscopic appendicectomy at Starship Children's Hospital between 1 January 2007-31 December 2016. RESULTS: During the study period, 2,793 children had appendicectomy using hook diathermy to dissect the mesoappendix. No children required blood transfusions or return to theatre for bleeding. There were 103 intra-operative complications related to the use of hook diathermy (3.7%), including one case that required conversion to open for bleeding. CONCLUSION: Dissection of the mesoappendix using hook diathermy is a safe, quick and effective method during laparoscopic appendicectomy, with low complication and conversion to open rates.