bluuebunny/crossref_metadata_2025 huggingface dataset:
SE12 THE RELATIONSHIP BETWEEN BURNOUT AND EMOTIONAL INTELLIGENCE IN AUSTRALIAN SURGEONS AND SURGICAL TRAINEES
Authors: Benson S. , Truskett P. G. , Findlay B.
Published: April 2007

The current study aimed to explore burnout prevalence rates and to examine the relationship between burnout and emotional intelligence in an Australian surgical population. The sample comprised 126 participants (53 SSTs, 73 Fellows; Mean age = 44.03 years, SD = 13.29).

Method  Participants completed a battery of self‐report measures of burnout, emotional intelligence, and social desirability. Measures achieved reliability coefficients between .68 and .89, indicating adequate internal consistency.

Results  A series of independent samples t‐tests indicated that burnout levels were significantly higher for the surgical sample than for other normative populations, with 47.6% of the sample reporting high general burnout levels. As predicted, younger surgeons reported significantly higher burnout levels, regardless of career stage. Burnout correlated significantly with early retirement and/or retraining intentions, and was inversely related to overall emotional intelligence levels. A series of regression analyses revealed that emotional control, emotional recognition and expression, and understanding of emotions were significant predictors of burnout. An exploration of gender differences found that females reported slightly higher general burnout levels.

Conclusion  A number of implications, limitations, and suggestions for further research were explored. It was concluded that burnout remains a significant problem for the surgical profession, with the potential for considerable personal, psychological, and societal impairment. The development of training interventions and further exploration of the aetiology of burnout was recommended, to ensure that impairment is minimised for individuals vulnerable to developing burnout.
SE15 SURGICAL TRAINING IN AN ERA OF REDUCED WORKING HOURS
Authors: Traynor O.
Published: April 2007

Across the world, federal regulations are imposing work hour restrictions on postgraduate medical trainees. Whilst welcomed by some specialties, this poses major challenges for craft‐based specialities such as surgery, which have traditionally relied on intensive exposure to a heavy caseload of clinical material to reach acceptable levels of proficiency. A new model of surgical training is required to ensure that reduced working hours and decreased clinical exposure do not impact negatively on surgical training or, ultimately, on patient safety. The Royal College of Surgeons in Ireland has developed a programme of surgical training which addresses the three major domains of surgical education: 1. Core Knowledge; 2. Technical skills; 3. Personal skills. The core knowledge component is delivered by a comprehensive online programme, SCHOOL for Surgeons. Cases are presented weekly and trainees are given assignments based on the cases. Assignments are submitted online, are graded by tutors and used as part of the annual performance appraisal. Technical skills are addressed in a surgical skills laboratory. Trainees attend six times per year and work to a defined syllabus for operative surgery. They are “signed‐off” on specific tasks and procedures before they progress (Proficiency Based Progression). The personal skills component is addressed through a defined syllabus, Human Factors in the Surgical Arena. Surgical, anaesthetic and nursing trainees work/learn together in this programme, designed to improve team performance and patient outcomes. We have found that a delivered education programme, targeted at the principal domains of surgical education, can mitigate the effects of reduced work hours.
SE17 THE ROLE OF E‐LEARNING IN SURGICAL EDUCATION
Authors: Traynor O.
Published: April 2007

Surgical trainees have traditionally acquired their core surgical knowledge (theory of surgery) through self directed study in libraries or at home, participation in classroom based courses, or attendance at national or international scientific meetings. Such learning inevitably occurs at a distance from the clinical setting and trainees usually studied individually. But the knowledge base that underpins surgical practice in the 21st century is ever expanding, posing an immence pedagogical challenge to surgical educators and trainees alike. The Royal College of Surgeons in Ireland has developed an online learning programme, SCHOOL for Surgeons, which is designed to allow trainees access information in their workplace, at the “point of care”. Clinical cases are presented (virtual grand rounds) and trainees have to work through the clinical presentation, differential diagnosis, investigation and management. The trainees work in “learning sets” and are given assignments which have to be submitted online. The assignments form part of their annual appraisal process. SCHOOL for Surgeons also incorporates an online journal club and also a “discussion room” for trainees. They may also download pod casts of keynote surgical presentations. The advantage of online learning is that it is available anywhere anytime, the content is focused and up to date and the medium is interactive. The development of an online programme allows standardisation of teaching across an entire country and has provided a more efficient way for surgical trainees to access and acquire core surgical knowledge.
SE02 THE VALIDITY OF AN INTEGRATED CLINICAL SIMULATOR FOR LEARNING LAPAROSCOPIC APPENDICECTOMY
Authors: Windsor J. A. , Loveday B. , Oosthuizen G. , Diener S.
Published: April 2007

Purpose  Attaining procedural competence requires a combination of specific cognitive and psychomotor skills. The Multimedia Clinical Skills Trainer (MCST, GoVirtual Medical Ltd) is software program that integrates text, anatomy, video and simulation for teaching a range of procedures. The purpose of this study was to determine the face, content and construct validity of MCST for laparoscopic appendicectomy (LA).

Methodology  The study was supported by the RACS. Basic surgical trainees (BST) in NZ were recruited and randomized into a control group and an intervention group. The latter received MCST for ad libitum use on their personal computers. Participant received three questionnaires: at the start of the study to determine demographics, at 2 weeks to assess knowledge and problem solving ability, and at four months to assess operative confidence and usefulness of MCST.

Results  Fifty‐eight BST’s were randomized. The first questionnaire was returned by 46% of participants, and third questionnaire by 44%. The intervention group scored more highly than the control group in the second questionnaire (14.69/20 vs 13.48/20). This difference was more apparent for first year BST’s (14.93/20 vs 12.13/20, p = 0.04). Operative confidence was similar at four months for the two groups. First year BST’s scored MCST more highly for its usefulness (5.2/7 vs 3.7/7, p = 0.04).

Conclusions  MCST has face, content and construct validity for BST’s learning LA, is a useful pre‐learning tool prior to clinical training opportunities, and can be used to measure knowledge and performance.
SE21 THE VALUE OF CLINICAL INDICATORS IN SETTING STANDARDS OR IMPROVING CLINICAL OUTCOMES
Authors: Beasley S. W.
Published: April 2007

Purpose  The Australasian Association of Paediatric Surgeons (AAPS) has collected Clinical Indicator (CI) data from virtually all the paediatric surgical institutions of Australia and New Zealand for the last five years. These CI’s were modified and expanded from the original ACHS/RACS specialty specific CI’s. This study reviews the CI data to determine the extent to which they have set standards or influenced the management of several paediatric surgical conditions.

Methodology  Analysis of AAPS CI data for pyloric stenosis, intussusception, appendicectomy and oesophageal atresia collected between 2001–2005 inclusive, and comparison with published outcome data for the same conditions.

Results  To date, the data have been accessed only rarely. For some of the CI’s, eg duodenal perforation during pyloromyotomy, the numbers have established a reliable benchmark rate (1.55% of 581 pyloromyotomies), and have already proved useful in the reconfiguration of services. For others, eg leak rate after repair of oesophageal atresia, the small numbers and complexity of confounding variables mean that they are unlikely to have any longterm value or application.

Conclusion  Well constructed CI’s provide data that can been useful to improve clinical outcomes. However, regular review is required to identify those that are unlikely to have useful application so they can be removed.
SE09 TRAINING OF FINAL YEAR MEDICAL STUDENTS IN PROCEDURAL SKILLS: IS IT WORTHWHILE?
Authors: Lushkott M. , Bissett I. P.
Published: April 2007

Purpose  Doctors graduating from medical school are immediately faced with performing many clinical procedures. This study aimed to assess whether the introduction of a new procedural skills course for final year students increased their confidence in performing these skills at qualification.

Methods  Students attending the final year procedural skills course were asked to complete a pre‐course, post‐course and end of year questionnaire scoring their confidence and experience in each of the procedures. Fifteen skills were taught in a simulated setting including; instrument handling, suturing, knot tying, local anaesthetic administration, plaster application, rectal examination, male catheterisation, nasogastric tube insertion, arterial blood sampling and lumbar puncture.

Results  The questionnaires were completed satisfactorily by 60, 64 and 93 students at the precourse, postcourse and end of year times respectively. There was a significant improvement in confidence for the 15 skills taught at the postcourse and end of year assessments over the precourse values (p < 0.0001 for all). By the end of the year (3–7 months later) there was a significant drop in confidence (p < 0.05) from the postcourse scores in 10 procedures that was not seen in local anaesthetic administration, rectal examination, preparing a sterile workplace, male catheterisation and arterial blood sampling. In these 5 procedures there was a significant increase in experience between the course and end of year.

Conclusion  Teaching procedural skills to final year medical students results in increased confidence in these skills at graduation and confidence is maintained best in those with ongoing experience in the procedure.
SH10 TEACHING AND LEARNING ANATOMY IN MELBOURNE OVER 150 YEARS
Authors: Collins J. P.
Published: April 2007

The teaching of anatomy which began unofficially in Melbourne 150 years ago was formally established with the passing of “An Act for Regulating Schools of Anatomy” in 1862 by the Victorian government. Armed with this Act, the University of Melbourne founded its medical school later that same year.

The development of anatomy teaching and the separation of anatomy from pathology one hundred years ago, is a colourful story in which several local personalities played their part. Commencing in an improvised outbuilding of his home, the first professor, George Halford began teaching anatomy in May 1863, the first such course in Australia. He was followed by Allen, Berry, Wood Jones and many others, each of whom was to make their own contribution.

The influence of surgeons including George Adlington Syme was paramount from the beginning and frequently the teaching of students only survived through their efforts. It was Wood Jones, who first drew attention to the negative aspects of the preservative formaldehyde and the artificial descriptions of anatomy which resulted. He warned in 1923, that “students will one day have to readjust their ideas, since they deal with the living but it is only now that living anatomy has fully taken its place in anatomy learning, through the use of telescopic views and the newer imaging techniques of the living body.

From simple beginnings, this department has evolved into a world leader in innovation and its award wining multi‐media package An@tomedia has brought the teaching and learning of anatomy into a new dawn.
SH11 THE MEDIEVAL ENGLISH CORONER
Authors: Sharp P. A.
Published: April 2007

The office of Coroner is a uniquely English institution. Scotland never had coroners. England exported her Coroner to almost everywhere coloured red in the Victorian atlas. The first mention of the Coroner dates from the reign of Alfred the Great. We have no records of that period.

The Coroner, as we know him today, dates from September 1194, during the reign of Richard the Lionheart whose interest in England was as a source of money to help finance his obsession with warfare.

Much of today’s English legal structure was born in the last decade of the 12th century. The edict that formally established the Coroners was Article 20 of the “Articles of Eyre” in September 1194. In 1195, Justices of the Peace were established. Ironically, they became the major reason for the decline of the Coroner in later centuries.

Coroners originally had to be Knights and men of substance. They were unpaid. Their prime function was to service the Royal Courts of Law, the General Eyre, which circulated slowly around the kingdom. This took so long to return to each county that, unless careful records were kept by the coroners, many cases never came to trial and potential revenue was lost to the Crown.

Other activities of the Coroner includes jurisdiction over “treasure troves”, shipwrecks and catches of royal fish: the whale and the sturgeon. Historically, his most important role, the only one to survive until today, was his role in the investigation of sudden death.
SH13 THE COLONIAL GATES OF THE MELBOURNE COLLEGE GARDENS SITE, RACS HEADQUARTERS
Authors: Murphy D. L.
Published: April 2007

The colonial past history of the College Gardens site in Melbourne was revealed during the excavations and building of the East Wing, Victorian Training and Education Centre (VTEC).

Research has revealed a golden history for this site, which we as Fellows of the College should be proud. The College site continues with its original purpose as a place of learning.

The choice of this site as the future RACS Headquarters involved decisions by our Founders. The College Museum plans for the site are progressing, enamel signage displaying the College site’s past history is proposed for the Skills Laboratory Forecourt.

This permanent display will provide a linkage between the history of this site to the current role of the VTEC, as a place of continuing education. It is fitting therefore that we look through the gates of that time to our future.
SH14 COLONEL (DR.) JOHN PAUL STAPP – CRASH TEST DUMMY, TRAUMA PREVENTION PIONEER & MURPHY’S LAW
Authors: Harden M. P.
Published: April 2007

Dr John Paul Stapp was not only the “fastest human on earth;” he was also the quickest to stop. In 1954, Dr Stapp attained a then world record land speed of 632 mph (1020 km/h), going from a stand still to a speed faster than a .45 bullet in 5 s on a rocket sled, and then to a dead stop in 1.4 s, all in the name of safety.

Stapp pioneered research on the effects of mechanical forces on living tissues during aircraft crashes. Stapp planned a series of tests on humans and set out to develop a harness to hold them. First, he used a dummy to perfect the harness and after 32 sled runs, he was ready to try it out on a human crash test dummy, himself. By 1954, Stapp had volunteered for 29 deceleration and windblast experiments. On his last run he sustained more than 40 g’s. He suffered fractured ribs and wrist, and retinal haemorrhages which left him temporarily blind.

Whilst at the Air Force Stapp also began a car‐crash study program to investigate fatalities in auto accidents. From this program, safety recommendations for the car industry were established including fastening seats more securely to the car body, improving bumper design and proving the effectiveness of seat belts. Stapp’s work resulted in the 3‐point restraint system of today’s belts which has saved millions of lives.

Stapp is also credited with coining one of the most famous phrases in history. One of his assistants, Capt E. Murphy, rigged a harness incorrectly yielding no data on the forces Stapp was subjected to. After discovering what happened, Stapp observed, “If there are two or more ways to do something and one of those results in a catastrophe, then someone will do it that way.” It has been called “Murphy’s Law” ever since.
SH15 CHURCHILL AT SEA
Authors: Beasley A. W.
Published: April 2007

Winston Churchill travelled a great deal by sea throughout his long life. This paper looks at some of his journeys and the ships in which they were made.
SH16 IMPOSTURES, DECEPTIONS AND CREDULITY
Authors: Magee H. R.
Published: April 2007

In the Cowlishaw Collection of the College Library, there is a little book by an anonymous author entitled “Some Sketches of Impostures, Deceptions and Credulity”. In a series if 26 chapters the author covers a variety of subjects including oracles, false messiahs, vampirism, malingering, medical delusions and many others.

Two notable examples of impostures and deceptions that played on the credulity of the public and the medical profession were Mary Tofts who claimed to have given birth to rabbits and Joanna Southcott, a self styled prophetess, who believed she had been impregnated by God and would give birth to a messiah.

Other examples of impostures were the report of the miraculous bullet, ruses used in malingering and Dr. Graham’s Celestial Bed.

All of these had some temporary popularity but were all recognised as falsehoods.
SH17 PROFESSOR ROBERT GOETZ – INNOVATOR AND PIONEER IN CORONARY ARTERY BYPASS SURGERY
Authors: Harden M. P.
Published: April 2007

Coronary artery bypass grafting (CABG) is one of the most significant surgical achievements of the 20th century. The contributions of Vineberg, Kolesoz, Favaloro and DeBakey are well known, but the name of Goetz means little to most surgeons. Goetz performed the world’s first successful CABG on May 2, 1960, in Bronx, N.Y.

Robert H. Goetz was born in Frankfurt on April 17, 1910 and studied medicine at the University of Frankfurt. In the 1950’s he studied the physiology of the giraffe, whose ability to lift its head from the ground to full height without fainting confounded zoologists, earning him the Vesalius Medal.

In 1960 Goetz developed a technique for coronary anastomosis on a beating heart using a tantalum ring on dogs. In an addendum to his article reporting this technique, Goetz announced the successful coronary mammary anastomosis between the right mammary and right coronary on a 38 year old man. The anastomosis was created in just 17 seconds. Before surgery the patient suffered from such debilitating angina that he needed 70 to 90 tablets of GTN a day. He remained pain free for 1 year and died of a posterior wall AMI. Angiogram at autopsy showed the anastomosis to be healed and patent.

This was to be the only CABG Goetz completed. Permission to present this case at a meeting of the American Association for Thoracic Surgery was denied, as it was felt that the subject of CABG was unimportant and should be forgotten. In 1982, Goetz retired from surgery and bred prize‐winning Angus bulls as a hobby and died on 15 December, 2000, in Scarsdale, N.Y. He was a remarkable academic surgeon with vision that aided the development of one of the most important surgical advances of the last 50 years.
SH06 WITTGENSTEIN AND THE CONCEPT OF “WOUND SHOCK”
Authors: Stewart G. J.
Published: April 2007

Ludwig Wittgenstein was one of the most influential and controversial philosophers of the 20th century. His ideas concerning the foundations of mathematics and the role of language remain of essential importance in these fields, while his eccentricities still warrant popular examination. During World War II, having relinquished his chair in philosophy at Cambridge University, he worked as dispensary porter and as laboratory assistant. In these roles and in association with the MRC Research Unit, initially at Guy’s Hospital, London and latter at the Royal Victoria Infirmary, Newcastle‐on Tyne, he was involved in investigations of what was then termed “wound shock”. These studies were carried out on air‐raid and latter industrial accident victims, under the leadership of Grant and Reeves, latter E.G, Bywater.

Today, we would recognise the poorly defined clinical syndrome of “wound shock” as manifestations of hypovolaemia. This entity had been recognised since the trench warfare of the First World War, but it is amazing to realise that as recently as the mid decades of the last century, the understanding of the physiology of injury was so rudimentary that this relationship was not recognised.

It is instructive to examine Wittgenstein’s role in discussion of the semantics of the term “shock”, which persists in causing confusion in the popular mind, as well as his experimental efforts. The development of understanding concerning hypovolaemic shock and crush injuries following the London Blitz shows how recently some of the most basic concepts on which we manage patients have become evident.
SH09 ANTARCTIC MEDICINE
Authors: Sharp P. A.
Published: April 2007

From the earliest classical cartographers, belief in the existence of a ‘Terra Australis’ was widespread. There had to be a great southern land to balance the geography of the world. Inexorable plate tectonics may have separated Australia and Antarctica 45 million years ago but it was only within the last few hundred years that Abel Tasman and James Cook isolated and defined them as separate lands for science, politics and strategy.

In 1901, the Australian colonies had just federated and formed a nation, the Commonwealth of Australia. The International Geographical Congress had proclaimed 1901 as ‘Antarctica’ year. The heroic age of Antarctic exploration was underway.

Antarctic medical practice is unique because there is no indigenous population.

This review starts with the primitive medicine practiced by doctors on board with Captain James Cook in 1775. The heroic era of Scott, Shackleton, Amundsen and Mawson was followed by a highly mechanized transition period and ends with modern medicine used in permanent stations and research.

In Antarctica, we have Earth’s remaining tenuous links with outer space (the last two great frontiers). NASA scientists have used Antarctica to test lunar survival strategies because ‘this is as close to lunar conditions as we could get here on Earth’.
SO10P A RETROSPECTIVE ANALYSIS OF WOUND INFECTION AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) IN CANCER PATIENTS
Authors: Lam T. , Spillane J. B. , Syme D. B. Y. , Wood R. , McPhail T. T.
Published: April 2007

Purpose  To determine infectious complications following PEG insertion with attention to the effect of chemotherapy, radiotherapy and timing of PEG insertion.

Methodology  A review of medical records of patients who underwent PEG insertion at a single institution between 1st July 2003 and 30th June 2005 was performed. PEG infection rate, antibiotic use, and concurrent chemotherapy and/or radiotherapy were recorded. Overall infection rate was calculated and a Quality Control Chart determined no evidence of an infectious outbreak.

Results  96 PEG procedures were performed. 92.8% of patients had head and neck cancers, 90.6% had squamous cell carcinoma, 64.6% had distant disease. 71 of 96 patients were male, mean age 61.2 yrs, mean BMI 22.1 kg/m2. Median length of stay was 8 days for infected patients and 5 days for non‐infected patients; median follow‐up 21 days and 19 days respectively. 56 patients had prior chemo‐radiotherapy, 17 radiotherapy alone, 4 chemotherapy alone and 19 had no prior treatment. 14.6% patients had an infection. 21.4% of infected patients did not receive prophylactic antibiotics. Type of cancer, stage of cancer, and co‐morbidities were not predictive of infection. Chemotherapy and/or radiotherapy treatment before, during or after PEG insertion was not statistically significant for PEG infection.

Conclusion  An infection rate of 14.6% was found, which falls within the range outlined by other authors. Our study investigated a patient group with tumours, the majority of whom had chemo‐radiotherapy around the time of PEG insertion. There was no statistical difference in infection rate due to timing of PEG insertion and no difference with the use of chemo‐radiotherapy.
SO11P A SYSTEMATIC REVIEW ON THE EFFICACY OF REPEAT HEPATECTOMY FOR RECURRENT LIVER METASTASES FROM COLORECTAL CARCINOMA
Authors: Sim J. , Yan T. D. , Black D. , Morris D. L.
Published: April 2007

Purpose  The objectives of this systematic review were to critically appraise the quantity and quality of current clinical evidence and demonstrate the efficacy of repeat hepatectomy for CRLM.

Methodology  Electronic searches for relevant studies published in peer‐reviewed journals on repeat hepatectomy for recurrent CRLM prior to September 2006 were performed on six databases. All articles identified were assessed with application of selection criteria. The quality of each included study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results.

Results  Seventeen studies with more than 20 patients were included for quality appraisal and data extraction. These 17 studies consisted of two multi‐institutional, one bi‐institutional and 14 single‐center observational studies. The overall perioperative morbidity rate ranged from 7–30% and mortality rate varied from 0–5%. The overall median survival since initial hepatectomy was 26 to 73 months. The overall median survival since the repeat hepatectomy ranged from 23 to 56 months, with 3‐ and 5‐year survival of 24–68% and 21–49%, respectively. The median disease‐free survival ranged from 9 to 52 months, with 3‐ and 5‐year disease‐free survival of 16–68% and 16–48%, respectively. After repeat hepatectomy the rates of recurrence in the liver and at an extra‐hepatic site were 15–67% and 27–64%, respectively.

Conclusions  The current literature suggests that repeat hepatectomy is associated with a prolonged survival for recurrent CRLM. Although all studies were observational case series, repeat hepatectomy is justified in selected patients, as there is a lack of evidence for alternative treatment.
SO13P CYTOREDUCTIVE SURGERY COMBINED WITH PERIOPERATIVE INTRAPERITONEAL CHEMOTHERAPY FOR DIFFUSE MALIGNANT PERITONEAL MESOTHELIOMA – ANALYSIS OF 100 CONSECUTIVE PATIENTS FROM A PROSPECTIVE DATABASE
Authors: Yan T. D. , Sim J. , Sugarbaker P. H.
Published: April 2007

Purpose  Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and invariably fatal neoplasm. Some studies have shown that cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) achieved an improved survival, as compared to historical controls. However, prognostic factors for survival have not been well defined.

Methodology  One hundred patients with DMPM underwent CRS and PIC at the Washington Center Institute. The inclusion criteria for surgery consisted of histological diagnosis of DMPM, age < 80 years, good performance status, and signed informed consent. All data were collected prospectively. Eight clinical and eight treatment‐related prognostic factors were analyzed for survival.

Results  The overall median survival was 52 months (range 1 to 148 months), with 1‐, 3‐, 5‐ and 7‐year survival of 78%, 55%, 46% and 39%, respectively. Univariate analysis showed that gender (p < 0.001), peritoneal cancer index (p = 0.009), lymph node status (p < 0.001), distant metastasis (p = 0.026), histological type (p < 0.001), intraoperative blood loss (p = 0.035), completeness of cytoreduction (p < 0.001), intraperitoneal chemotherapy regimen (p = 0.041), and redo cytoreductive surgery (p = 0.022) were significant for survival. Multivariate analysis demonstrated that female gender, absence of lymph node involvement, epithelial/multicystic type, and adequate cytoreduction were independently associated with an improved survival.

Conclusions  CRS and PIC showed an improved survival for DMPM, as compared to historical controls. Long‐term survival was associated with female gender, absence of lymph node involvement, epithelial or multicystic type and adequate cytoreduction.
SO15P PERCUTANEOUS RADIOFREQUENCY ABLATION OF LUNG TUMOURS: PROGNOSTIC RISK FACTORS FOR LOCAL PROGRESSION
Authors: Ng K. , Yan T. D. , Zhu J. C. , King J. , Glenn D. , Morris D. L.
Published: April 2007

Purpose  The purpose of this series was to evaluate the prognostic features for local progression in non‐surgical candidates after undergoing percutaneous RFA of lung tumours.

Methodology  From Nov 2000, a total of 233 lung neoplasms (9 primary) in 95 patients (56 males, mean age of 66 years) with a mininum follow‐up of 6 months were included in this study. The primary end point was local progression free interval defined from the time of RFA intervention. Local progression was defined as tumour recurrence of previously RFA treated site/s. Univariate and multivariate analysis were performed to identify significant prognostic parameters for post‐ablative tumour recurrence.

Results  The mean number of tumours ablated per patient was 2.5 while the mean diametre of tumours was 2.2 cm. After a median follow up period of 24 months (range: 6–54 months), 32% of ablated tumours recurred. The overall median local progression free interval was 20 months (range 3–54 months) with 1, 2 and 3 year local progression free survival of 82%, 74% and 68% respectively. Univariate analysis of lesion characteristics identified size (p = 0.0002), hilar location (p = 0.0141), proximity to bronchus (p = 0.009) and vessel (p = 0.001), number of ablations required per lesion (p = 0.0052) and post‐ablation and tumour volume ratio (p = 0.0002) as statistically significant prognostic factors for tumour recurrence. Multivariate analysis identified size of lung tumours >3 cm (p = 0.07) as an independent risk factor for local progression.

Conclusion  Percutaneous lung RFA may play a useful role as a local therapy in non‐surgical candidates with pulmonary neoplasms. However, the efficacy of local control may be restricted to lesions smaller than 3 cm.
SO04 CYTOREDUCTIVE SURGERY AND PERIOPERATIVE INTRAPERITONEAL CHEMOTHERAPY FOR PERITONEAL CARCINOMATOSIS FOR COLORECTAL CARCINOMA
Authors: Sathasivam S. , Yan T. , Chu F. , Morris D.
Published: April 2007

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been reported as a treatment option for patients with peritoneal carcinomatosis from colorectal carcinoma.

This prospective study was to report survival outcomes and evaluate the significant prognostic factors for overall survival in 30 patients who underwent CRS and PIC.

No patients were lost to follow‐up. Univariate analysis was performed to evaluate the significant prognostic factors for overall survival, defined from the time of surgery. Survival analysis was performed by using the Kaplan‐Meier method and compared using the log rank test.

The median survival was 29 months (range 2–39 months). No patients died in the post‐operative period. The 1‐ and 2‐year survival rates were 72% and 64%, respectively.

Six clinicopathologic factors and one treatment‐related factor for overall survival were analysed by univariant analysis. Clinicopathological factors included gender, age, timing of the surgery, histological grading, liver metastases and Peritoneal Cancer Index (PCI). Treatment‐related factors included operative duration, length of hospital stay, completeness of cytoreduction and peri‐operative morbidity. Three factors were significant for overall survival: non‐mucinous colorectal adenocarcinoma (versus mucinous, p = 0.047), PCI < 13 (versus > 13, p = 0.016), and complete cytoreduction (versus incomplete, p = 0.030).

Non‐mucinous colorectal adenocarcinoma and PCI < 13 were associated with an improved survival in the 30 patients who underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis.
SO06 EXTRATHORACIC SOLITARY FIBROUS TUMOURS: OUTCOME OF 33 CASES
Authors: Cranshaw I. M. , Thway K. , Fisher C. , Hargreaves W. , Hayes A. J. , Thomas J. M.
Published: April 2007

Purpose  Extrathoracic solitary fibrous tumours (SFT) have traditionally been regarded as less aggressive than their intrathoracic counterparts. However there has been some evidence that a subset of more aggressively malignant tumours exist. We examined our experience with these rare tumours in an effort to clarify their clinicopathological behaviour and relate this to their histopathological findings.

Methodology  All patients with a histopathological diagnosis of SFT who presented to the Royal Marsden Hospital between 1998 and 2006 were reviewed. Clinicopathological data were recorded for all cases and comparisons made using Fishers exact test and calculating Odds ratios (OR).

Results  There were 33 cases included in the study. 18 (55%) cases had malignant features on histological examination and these cases were associated with significantly increased rates of local recurrence (OR 16.21 p 0.021), metastatic disease (OR 8.91 p 0.046) and death (OR 38.29 p < 0.01). Tumours within the abdominal cavity or retroperitoneum were associated with a higher rate of local recurrence compared to those in the limbs (OR 21.67 p < 0.01). One case with benign histopathology developed metastatic disease at 102 months of follow‐up.

Conclusion  In our experience extrathoracic SFT have a higher rate of malignant behaviour than that classically described. Those tumours with atypical or malignant features on histological examination should be closely monitored and followed up in the same manner as other high grade soft tissue tumours. Even histologically benign tumours occasionally behave in a malignant fashion.
SO07 LAPAROSCOPIC VERSUS OPEN TOTAL MESORECTAL EXCISION: A CASE‐CONTROL STUDY
Authors: Breukink S. O. , Pierie J. P. E. N. , Grond A. J. , Hoff C. , Wiggers T. , Meijerink W. J. H. J.
Published: April 2007

Purpose  Because definitive long‐term results are not yet available, the oncological safety of laparoscopic surgery for treatment of rectal cancer remains unproven. The aim of this prospective non‐randomized study was to assess the feasibility and short‐term outcome of laparoscopic total mesorectal excision (LTME) after 25–30 Gy preoperative radiotherapy and to compare the results with a matched‐control group of open TME (OTME).

Methodology  A series of 41 patients with primary rectal cancer underwent LTME for rectal cancer and were matched with a historical control group of 41 patients who underwent OTME. Both groups received preoperative short‐term radiotherapy.

Results  There was no mortality in the LTME group and 2% mortality in the OTME group. The overall postoperative morbidity was 37% in the LTME group and 51% in the OTME group, including an anastomotic leakage of 9 and 14% in the LTME and OTME groups respectively. A positive circumferential margin was found in 7% of patients in the LTME group and in 12% of the patients in the OTME group.

Conclusion  This study shows that LTME is technically feasible and can be performed safely. We show at least a similar surgical completeness using a laparoscopic technique.
SO08 MANAGEMENT OF COMPLEX LARGE VOLUME GROIN TUMOURS WITH RECTUS ABDOMINUS MYOCUTANEOUS FLAPS – A CASE SERIES
Authors: Cranshaw I. M. , Fischer P. , Stainio J. , Thomas J. M.
Published: April 2007

Purpose  Resection of large volume soft tissue tumours and metastatic disease in the groin commonly involves extensive resection of abdominal wall and overlying skin to achieve adequately wide surgical margins. There are many reconstructive techniques available often requiring specialised plastic surgical input. We have routinely used vertical rectus abdominus myocutaneous flaps (VRAM) to reconstruct these defects and our impression was that these simple flaps provided good cover with few complications.

Methodology  A search of our operative database between 1999 and 2005 to identify large volume groin tumours which had been immediately reconstructed with a VRAM. We recorded information on patient demographics, tumour characteristics, reconstruction type, postoperative complications, follow‐up and survival data.

Results  18 patients fulfilled our criteria and were included in the study. Tumour pathology was sarcoma 11 (61%), melanoma 4 (22%) and squamous cell carcinoma 3 (17%). Only 6 cases were potientially curative resections for primary tumours with, 5 palliative procedures for recurrent sarcoma and 7 for metastatic. Patients with palliative resections did poorly with and average survival of 17 months (range 6–36 months) but complications were uncommon with partial flap necrosis requiring split skin grafting in one case only. Curative resections had no local recurrences and one death from disease at 44 months.

Conclusion  VRAM reconstruction following resection of large volume groin tumours was very successful in our series providing excellent cover in the groin with few complications. The technique is useful in achieving robust surgical palliation and appears equally effective for potentially curative cases.
SO09 PERCUTANEOUS RADIOFREQUENCY ABLATION OF LUNG TUMOURS: RESULTS IN FIRST 100 CONSECUTIVE PATIENTS
Authors: Zhu J. C. , Yan T. D. , Ng K. , King J. , Glenn D. , Morris D. L.
Published: April 2007

Purpose  The study reported our experience with first 100 consecutive patients who underwent radiofrequency ablation (RFA) of their unresectable malignant lung tumours.

Methodology  From Nov 2000 to Dec 2006, the clinical and treatment‐related information regarding the 100 consecutive patients (58 males, mean age of 65 years) with 240 lung tumours treated by RFA were collected prospectively and reviewed retrospectively. RFA was performed under CT guidance with local anaesthetics and conscious sedation. The patients were followed up with chest CT at regular intervals.

Results  Five patients had primary lung carcinoma while the remaining patients had pulmonary metastases from extra‐thoracic malignancies, with colorectal cancer being the most common primary site (70%). The mean number of pulmonary lesions ablated was 2.4 per patient; the mean size of lesion was 2.2 cm in diameter. Nineteen patients had repeat RFA for recurrent or residual pulmonary disease. There was no post‐procedural mortality and the overall morbidity rate was 42%. The most common complication was pneumothorax, which occurred in of 31% of procedures (n = 39/127) with only 20 (16%) requiring chest tube placement. After a median follow‐up of 24 months (range 1 to 70 months), 72% of RFA treated lesions did not progress. The overall median disease‐free interval was 13 months, with 1‐, 3‐ and 5‐year disease‐free survival of 55%, 22% and 7% respectively. The overall median survival was 34 months with 1‐, 3‐ and 5‐year‐survival of 85%, 49% and 33% respectively.

Conclusion  Percutaneous RFA is an emerging therapy with promising results when surgical resection of pulmonary malignancy cannot be performed.
TN10 MOVING FROM TISSUE TRANSPLANTATION TO TISSUE ENGINEERING – IMMUNOLOGIC SURVEY OF A PROSPECTIVE SCAFFOLD
Authors: Varkey A. , Huang L. H. , Shieh S. J.
Published: April 2007

Purpose  To highlight the design process for tissue engineered mucosa and evaluate the results of an in – vivo immunologic survey done in an animal model.

Methods  21 Sprague Dawley rats were divided into three groups to study the systemic immune response to our developed biomaterial, with two other materials used for comparison. Serial subcutaneous implantation was done to serve as antigenic booster .The animals were sacrificed after a 31 day period and their spleens were harvested, digested to make single cell suspensions and used flow cytometry to quantitate CD4+ and CD8+ cells. The CD8+ cells counts are a reflection of the immuno‐toxicity of the material.

Results  CD 4+ and CD8+ counts were expressed as a percentage of total cells. The mean and standard deviation of CD8+ counts of our potential scaffold material was 19.782 ± 4.021 as compared to Duragen which was 21.574 ± 3.837 and the group with porcine skin 19.598 ± 3.678.

Conclusions  Striving towards the goal of creating a bioengineered mucosa requires an optimal scaffold with proven immunologic safety. We have attempted to study the systemic immunologic response by comparing our biomaterial with existing materials that are already in clinical use. Though absolute values of CD8+ are comparable and within the same range, larger trials will be needed to establish significant benefits of one over the other.
TN02 RADIOLOGICAL ASSESSMENT OF LIVE LIVER AND KIDNEY DONORS
Authors: Holden A. H.
Published: April 2007

Technical success with minimal morbidity for both donor and recipient in live hepatic and renal donor surgery can be achieved by accurate pre‐operative assessment, including high quality imaging of donor hepatic and renal anatomy. Invasive imaging modalities such as angiography and ERCP have been replaced by the non‐invasive imaging modalities multidetector CT (MD‐CT) and MRI.

The aims of pre‐operative imaging of potential hepatic donors include the assessment of hepatic vascular anatomy, biliary anatomy, diffuse hepatic parenchymal conditions such as steatosis, focal hepatic lesions and liver volumetry. There are constant improvements in both CT and MR technology and the local choice of modality may be influenced by availability and local expertise. Both MD‐CT and MRI can be used to assess hepatic arterial, portal venous and hepatic venous anatomy as well as liver volumetry. The temporal and spatial resolution of MD‐CT possibly allows more accurate assessment of hepatic arterial anatomy.

Biliary anatomy requires accurate assessment as biliary complications are the most common cause of post operative morbidity. MRCP techniques, particularly recent 3‐dimensional free breathing techniques and MD‐CT with either oral or intravenous cholangiographic agents (CTCP) can provide high resolution cholangiographic imaging. Hepatic steatosis involving the donor is qualitatively assessed with chemical shift MR producing most sensitive assessment.

MD‐CT is frequently used in the assessment of potential renal donors with arterial, venous and collecting system variants relatively common. Early main renal artery branching, capsular arteries and large systemic venous tributaries all require recognition.
TN04 BIOELECTRICAL IMPEDANCE PHASE ANGLE IN CHRONIC LIVER DISEASE AND LIVER TRANSPLANTATION
Authors: Mathur S. , McCall J. L. , Gane E. J. , Plank L. D.
Published: April 2007

Introduction  Phase Angle (PA), determined using bioelectrical impedance, may be altered in chronic liver disease. We aimed to determine whether 1. PA predicts survival in cirrhotic patients and 2. PA improves after nutritional support and transplantation.

Methods  Data were extracted from a prospective database of 252 cirrhotic patients referred for nutritional assessment and intervention (HCC excluded). Median age was 49 (16–73), 68% male. Aetiology was viral (55%), ALD (15%), cholestatic (11%), and other (19%), with median MELD 11 (6–36). Measurements included PA and total body protein (TBP). Patients were followed for a median 53 (4–93) months. Survival and logistic regression analysis were performed.

Results  138 (55%) died or were transplanted during follow‐up. Low PA (<4.4%) was associated with worse survival (median 16 vs. 57 months, P = 0.02) independent of the MELD score (HR for MELD 1.18; 95% CI 1.05–1.32, P < 0.0001 and for PA 0.56; 95%CI 0.32–0.98, P = 0.046). In 93 patients followed for 100 days after nutritional intervention, TBP increased by 200g (P = 0.04) and PA increased from 4.8% to 5.2% (P = 0.0006). PA also increased from low to normal levels one year post‐OLT (4.9% to 5.7%, P = 0.0001, n = 69).

Conclusion  Low PA correlates with reduced TBP and a higher risk progression to transplantation or death. PA improves after nutritional support and transplantation.
TN05 NATURAL HISTORY OF TRANSPLANT RENAL ARTERY STENOSIS
Authors: Heer M. K. , Trevillian P. R. , Hardy D. , Hibberd A. D.
Published: April 2007

Introduction  Integrity of Transplant Renal Artery is crucial for long term survival of the graft. Literature regarding the evolution of Transplant Renal Artery Stenosis (TRAS) is scant.

Method  Retrospective analysis of 1042 duplex scans in kidney transplant recipients. Duplex scan (GE VIVID 307, multiphase transducer) was used as routine screening modality. Time period 1999–2006. Total no of patients −148. Mean age 47.4 yrs. M : F: 83 : 65. Average follow up −2.45 yrs. Renal arterial ratio and peak systolic velocities were used as absolute criteria for diagnosis. Relative criteria used were parenchymal perfusion, size of kidney, resistive indices and presence of other vascular conditions.

Results  Number of patients detected to have TRAS‐50. Mean age‐ 48.36 yrs. M : F: 29 : 21. Average time period for detection of stenosis – 193 days. 20 patients had ostial stenosis, 23 – mid segment, 1 at hilum, 2 – branch and 4 – throughout length of artery. Two groups: Early stenosis i.e. within 3 mo – 36(72%) patients. Late stenosis – 14 (28%) patients. Average time to detect early stenosis 74 (10–100) days and late stenosis 502 (140–1396) days. 21/36 patients in group 1 showed complete resolution of stenosis in an average time of 270 days whereas only 3/14 patients in the late group resolved at an average period of 375 days (p = 0.019).

Conclusion  Routine duplex scans can detect significant numbers of TRAS. Stenosis occurring early post transplant are more likely to resolve than late occurring stenosis. Prospective controlled studies are needed to resolve the issue.
TN08 THE EARLY EXPERIENCE OF ABO‐INCOMPATIBLE RENAL TRANSPLANTATION IN AUSTRALIA
Authors: Nordstrand I. A. J. , Robertson A. J. , Francis D. M. A. , Cohney S. J. , Walker R. G. , Hogan C. J.
Published: April 2007

Purpose  In the presence of static cadaveric donation rates, renal transplantation relies increasingly on living donors. ABO blood group incompatibility has traditionally prevented many potential living donors from donating because risk of hyperacute rejection/antibody‐mediated rejection (AbMR) with graft loss, with or without need for concurrent splenectomy and intense immunosuppression. Pre‐ and post‐transplant antibody removal and monitoring anti‐blood group antibody levels have allowed this to become a clinical possibility. We report results on the first ten ABO incompatible kidney transplants performed in Australia at The Royal Melbourne and Melbourne Private Hospitals, without splenectomy.

Method  All patients underwent transplantation after two weeks of Mycophenolate Mofetil, and antibody removal (plasma exchanges or Glycosorb columns). Three patients received Rituximab pre‐transplant. Standard immunosuppression was commenced at transplantation. All patients, except one low‐titre A2/O patient, received post transplant antibody removal. None underwent splenectomy.

Results  Thirty day mortality was zero, and at median six‐month follow‐up, there have been no episodes of rejection or opportunistic infections. All transplants are currently functioning. Two patients developed urosepsis, one post‐transplant diabetes. Two patients required reoperation and ureteric reimplantation for ureteric leakage.

Conclusion  ABO incompatible transplantation can be performed without excessive immunosuppression and with low morbidity. Preservation of the spleen reduces operative risk, post‐operative complications and the added vulnerability to infection.