Risk factors for recurrence in colorectal cancer: a retrospective analysis in a regional Australian hospital.

BACKGROUND: Colorectal cancer is the third most commonly diagnosed malignancy in Australia. Up to a third of patients who have undergone surgery with curative intent for colorectal cancer will have a recurrence of disease leading to significant morbidity and mortality. Regional Australians have disproportionately worse outcomes. AIM: To identify factors associated with recurrence in colorectal cancer patients treated at a regional Australian hospital. METHODS: This study is a retrospective cohort analysis. Consecutive patients who have undergone curative resection at a regional public and private hospital by three surgeons from a single surgical practice for either rectal cancer or colon cancer were included. Prognostic indicators of recurrence were examined via both univariate and multivariate time-to-event analyses. RESULTS: Three hundred nine patients were included with 43 recurrences. Thirty presented with distant metastases, seven presented with locoregional recurrence and six presented with locoregional as well as distant recurrence. In univariable analysis, higher rates of recurrence were associated with tumour type, higher AJCC summary stage, higher preoperative levels of CA19-9, perineural invasion, lymphovascular invasion, <12 nodes examined, positive lymph nodes and emergency surgery status. On multivariable analysis recurrence remained associated with tumours with a mucinous and/or signet cell component, positive nodes and <12 lymph nodes examined. CONCLUSION: A combination of patient and treatment factors are relevant in determining the risk of recurrence for stage I-III colorectal cancer. This study emphasises the importance of histology in determining risk, particularly the number of nodes examined. CEA 19-9 may also be a useful pre-operative predictor of recurrence.

Caseload distribution of general surgeons in regional Australia: is there a role for a rural surgery sub-specialization?

BACKGROUND: Rural and regional Australia presents a unique challenge in the delivery of surgical services by virtue of its geographical vastness and low population density. While up to 33% of Australians live in rural or regional areas, only 14.8% of surgeons work in a rural or regional area. Data regarding the caseload distribution of general surgeons working in a regional setting in Australia remain scarce. In order to better examine the training needs of rural general surgeons, this study aims to examine the caseload distribution of general surgeons working in regional Australia. METHODS: A retrospective review of surgical procedures carried out by general surgeons at Albury Base Hospital between September 2006 and December 2014 was carried out. Surgical procedures were grouped according to the classifications of the Royal Australasian College of Surgeons Morbidity and Audit Logbook Tool. RESULTS: During the study period, 21 652 procedures were carried out by general surgeons. A total of 58.7% (12711) of these procedures consisted of general surgical procedures and 35.9% (7763) were endoscopic procedures. A total of 5.4% of procedures carried out by general surgeons fell outside the scope of traditional general surgery, including cardiothoracic, orthopaedic, ear, nose and throat, neurosurgical, vascular and urological procedures. All general surgeons performed operations in surgical specialities outside of general surgery. CONCLUSION: This study adds weight to the value of a broad skill set in provision of surgical services in a rural setting.

Pseudoaneurysm of the hepatic artery.

INTRODUCTION: Hepatic artery pseudoaneurysms are a rare complication of biliary tract surgery and have an associated mortality that approaches 50%. CASE REPORT: A case of massive haemobilia caused by a hepatic artery pseudoaneurysm several months following laparoscopic cholecystectomy is described. DISCUSSION: It was successfully managed by angiographic embolisation, with the patient making a complete recovery.