ANZ Journal of Surgery

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Syndicate content
Wiley Online Library : ANZ Journal of Surgery
Updated: 8 hours 31 min ago

Author Index

April 17, 2017 - 11:20

Abstract Journal Colorectal Surgery

April 17, 2017 - 11:20

Abstract Journal Military Surgery

April 17, 2017 - 11:20

Abstract Journal Orthopaedic Surgery

April 17, 2017 - 11:20

Abstract Journal Rural Surgery

April 17, 2017 - 11:20

Issue Information

April 17, 2017 - 11:20

Abstract Journal General Surgery

April 17, 2017 - 11:20

Abstract Journal HPB Surgery

April 17, 2017 - 11:20

Abstract Journal Trauma Surgery

April 17, 2017 - 11:20

Associating Liver Partition and Portal vein ligation for Staged hepatectomy after pre-operative chemotherapy

April 17, 2017 - 06:50
Background

Recently a procedure termed ‘Associating Liver Partition and Portal vein ligation for Staged hepatectomy’ (ALPPS) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and pre-operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS.

Methods

Retrospective analysis was performed on six patients suffering from advanced CRLM. Analyses comprised demographical and basic clinical data, the perioperative courses as well as short- and long-term outcomes.

Results

All patients presented with bilobular CRLM and pre-operative chemotherapy of at least 6 months. Extended right hemihepatectomy was performed in all cases, four patients additionally received atypical resections in segments II/III. Mean FLR prior to step 1 of ALPPS was 397.9 cm3 (121–753 cm3), on average representing 20.9% of the total liver volume (13.2–27.1%). A mean hypertrophy of the FLR of 67.9% (32.5–94.1%) was achieved. Overall, severe morbidity (Dindo Clavien >3a) occurred in two patients. Following completion of ALPPS, mean post-operative disease-free survival was 5.7 months (2.6–8.9 months).

Conclusion

Despite pre-operative chemotherapy, ALPPS seems to result in adequate liver hypertrophy, preventing post-operative small-for-size syndrome. However, there might be a high risk of tumour recurrence in patients with an aggressive tumour biology.

Total thyroidectomy for pressure symptoms in patients with Hashimoto's thyroiditis

April 17, 2017 - 06:50
Background

Hashimoto's thyroiditis (HT) is rarely on its own the indication for thyroidectomy. However, surgery in patients with HT will be undertaken when there is malignancy and may be required for pressure symptoms. Therefore, this study aimed to investigate the indications for surgery in HT patients.

Methods

The Monash University Endocrine Surgery Database was analysed from 1994 to 2013 for patients with HT. Patients with HT were compared to a similar group of patients with no HT on histopathology. Patient demographics, indication for surgery, histopathology, gland weight and complications were analysed.

Results

A total of 2346 patients underwent total thyroidectomy during the study period. The median age was 55 years. Eleven percent of patients had HT on final pathology (259/2346). HT patients reported more pressure symptoms, 25.5% compared to those with other pathology, 18.9% (P = 0.01). Patients with pressure symptoms had heavier glands, 113 g compared to 85 g in those with other indications for surgery (P = 0.048). Within the HT cohort, the median gland weight was 66 g compared to 93 g in those without HT (P < 0.01). On multivariate analysis, pressure symptoms as an indication for surgery was associated with HT (P < 0.01), but age, gender and gland weight were not associated. In patients operated for pressure with HT as the only pathology, 90% had relief of pressure symptoms.

Conclusion

Patients with HT were more likely to have pressure symptoms as an indication for surgery independent of gland weights.

Table of contents

April 3, 2017 - 16:24