Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for Women, Sydney.

BACKGROUND: There appears to be a rise in the rate of emergency peripartum hysterectomy (EPH) in the developed world. AIMS: To determine the incidence, indications, risk factors, complications and management of EPH in our tertiary level teaching hospital, the Royal Hospital for Women (RHW) in Sydney, over the last decade. METHODS: A retrospective analysis was conducted of all cases of EPH performed at the RHW between the years 1999-2008 inclusive. EPH was defined as one performed after 20 weeks gestation for uncontrollable uterine bleeding not responsive to conservative measures occurring at any time after delivery but within the first 6 weeks post-partum. Cases were ascertained via our hospital obstetric database. RESULTS: There were 33 EPH among 38,998 births, a rate of 0.85 per 1000 births. Indications for EPH were morbid adherence of the placenta (54.8%), placenta praevia (19.4%), uterine atony (12.9%) and uterine rupture or cervical laceration (9.7%). A significant association between previous caesarean section (CS) and abnormal placentation was confirmed (P=0.011), especially for morbid adherence of the placenta (P=0.004). There was one maternal death. Maternal morbidity was significant, with disseminated intravascular coagulation and urinary tract injury among the most common complications. All women required blood transfusions, and over a quarter were admitted to the intensive care unit. CONCLUSIONS: In our series, abnormal placentation causing severe haemorrhage was the commonest indication for EPH. Previous CS is a risk factor for abnormal placentation and particularly for morbid adherence of the placenta. The morbidity associated with EPH is considerable.

Gastric cancer: Australian outcomes of multi-modality treatment with curative intent.

BACKGROUND: Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Large Western trials have shown overall 5-year survival rates of 36-47%. Surgical resection remains the mainstay of curative treatment. We report the outcomes at a single Australian centre. METHODS: We analysed a prospectively kept database of patients after gastric resection for adenocarcinoma at a tertiary Australian hospital. Disease-specific survival (DSS) was considered the primary end-point. RESULTS: One hundred and seventy-three patients underwent gastrectomy with curative intent. Average age at diagnosis was 68, with 72% being male patients. One hundred patients had a total gastrectomy and 73 had subtotal. The average number of lymph nodes examined was 23. All patients were discussed in a multidisciplinary setting. Perioperative morbidity rate was 31%, with 3.5% 30-day mortality. Five-year DSS was 67.4% with 91.2%, 76.7% and 39.3% for stage 1, 2 and 3 disease, respectively. Five-year overall survival considering death from any cause was 47.4%. CONCLUSION: This large Australian single centre study shows outcomes equivalent to other Western series and approaches that of Japanese data. High survival figures can be achieved when gastrectomy is performed by an experienced institution through a multi-modality approach with adequate staging, aggressive and appropriate resection and selective use of perioperative therapy.