Why Taranaki women choose to have a mastectomy when suitable for breast conservation treatment.

BACKGROUND: Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate may reflect the requirement for Taranaki women to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT. METHODS: Prospective information, on all women presenting with breast cancer between May 2004 and December 2006, was collected on a standardized questionnaire. RESULTS: BCT was offered to 68% (140 of 206), but chosen by only 46% (n = 64) of suitable patients. If radiotherapy had been available locally, 23% (17 of 73) of patients who chose mastectomy would have instead opted for BCT. A quarter of each group of women thought they knew their surgeon's treatment preference and most chose this option. Fear of local recurrence and need for further surgery were significantly more important to those choosing mastectomy over BCT whereas what the surgeon was perceived to prefer was more important to those choosing BCT. CONCLUSION: The rate of BCT in Taranaki is low, despite it being offered by surgeons to the majority of patients. Local availability of radiotherapy may increase the BCT rate to a level more consistent with larger centres in New Zealand. Care must be taken to provide neutral patient guidance.

Prospective audit of colorectal resections in a peripheral public hospital.

BACKGROUND: Colorectal disease requiring surgery is common in New Zealand where there is no established national colorectal screening programme. We established an audit to review our current practice in colorectal surgery. METHODS: Prospective audit data were collected on consecutive patients undergoing colorectal resection between April 2003 and December 2004, using a standardized pro forma. RESULTS: In all, 170 colorectal resections were carried out of which 117 (69%) were for malignancy and 120 (71%) were elective. Median patient age was 72 years (interquartile range 62-78 years) and median length of stay was 10 days (interquartile range 8-14 days). Colonoscopy was the most common method of investigation. In elective patients with malignancy, the average delay between onset of symptoms and surgery was 25 weeks. Duke's stage C was the most common stage at presentation (44%). Complications developed in 83 (49%) of patients including 20 (12%) patients returned to theatre, 5 (3%) anastomotic leaks and 8 deaths (5%). In patients undergoing surgery aged over 80 (n = 40) the median length of stay was 10 days (7-14) with a complication rate of 21 (55%) including 5 (13%) who were returned to theatre and 6 (16%) deaths. CONCLUSION: This audit has confirmed that there is an acceptable level of care at Taranaki Base Hospital when compared with those in published work. Elective patients with malignancy have a delay of nearly 6 months between the onset of symptoms and surgery. Patients in Taranaki are more likely to present with an advanced stage of tumour compared with other unscreened populations.

Laparoscopic nephroureterectomy complicated by rupture of adrenal artery pseudoaneurysm.

We present a case of ruptured adrenal artery pseudoaneurysm as a complication of laparoscopic nephroureterectomy. An 87-year-old woman with hematuria and transitional cell carcinoma on imaging underwent laparoscopic nephroureterectomy. Her postoperative recovery was uneventful until day 17, when she presented with severe abdominal pain, syncope, and significant anemia. An aneurysm was suspected on computed tomography and Doppler ultrasonography. Selective angiography showed a pseudoaneurysm of the adrenal artery that could not be successfully embolized. Exploratory laparotomy obtained hemostasis, and the pseudoaneurysm was identified as involving an adrenal artery next to a surgical clip, which is speculated to be the cause.