bluuebunny/crossref_metadata_2025_split huggingface dataset:
HN05 ADVANCES IN THE MANAGEMENT OF LARYNGEAL DYSPLASIA AND CARCINOMA IN‐SITU
Authors: Broadhurst M. S. 
Published: April 2009

Introduction:   Pre‐cancerous lesions of the larynx are common and can progress to invasive carcinoma. Such lesions, usually of the true vocal folds, may then require surgical resection or irradiation with subsequent morbidity of treatment. There is currently no gold standard treatment of glottal dysplasia. Instead, one adopts “watchful waiting” until intervention is deemed necessary at the point of malignant degeneration. Recently, evolving photoangiolytic laser techniques utilizing the pulsed potassium‐titanyl‐phosphate (KTP) laser have provided a successful treatment modality in place of “watchful waiting” minimizing progression to invasive carcinoma.Methods:   The treatment process and outcome in 4 months of consecutive patients with dysplasia/carcinoma in‐situ was studied. Videophotographic analysis was performed at presentation, during treatments and with follow‐up. Acoustic voice measurements were conducted. Patient treatment consisted of operating theatre and office‐based pulsed‐KTP laser photoangiolysis to involute the disease. The end point was percentage of macroscopic disease regression.Results:   Five patients underwent initial office assessment, 1–2 operating theatre treatments and 1–2 office‐based treatments depending on disease response. All patients showed complete or near‐complete involution of dysplasia/CIS and the underlying pliability was preserved or improved. Since the institution of this treatment in Australia 6 months ago, no patient has progressed to invasive cancer.Discussion:  Pulsed‐KTP photoangiolysis provides a new approach to manage pre‐malignant lesions of the true vocal folds. This enables the trained surgeon to adopt cancer prevention in place of currently practiced watchful waiting.
HN06P COMBINED LASER SURGERY AND ADJUVANT RADIATION THERAPY FOR EARLY LARYNGEAL CANCER
Authors: Mistry R. M. , Gregor R. T. 
Published: April 2009

Objective:   The primary objective of this study was to compare outcomes of patients who underwent combined laser surgery and adjuvant radiation therapy with patients who underwent laser surgery alone for the treatment of early laryngeal cancer.Methods:   A retrospective review of patients who underwent endoscopic laser surgery for early laryngeal cancer between 2000 and 2005 at Waikato Hospital. We compared outcomes for patients who underwent laser surgery alone with those who underwent laser surgery and adjuvant radiation therapy. We reviewed these patients with regards to their demographics, disease stage, treatment, and post‐operative outcomes.
HN07P SMOKING CESSATION IN PATIENTS UNDERGOING TREATMENT FOR HEAD AND NECK CANCER
Authors: Rajpal K. , Mackinnon C. A. , Tan S. T. 
Published: April 2009

Aim:   Advice on smoking cessation is part of our overall management for head and neck cancer patients. This study determined the effectiveness of smoking cessation strategy, contributing factors, and long‐term abstinence in these patients.Method:   Consecutive patients who smoked at the time of diagnosis were culled from our head and neck database. Demographic data, diagnosis and tumour location were recorded. The patients were sent a questionnaire to document their smoking habits, factors that influenced cessation and the interval of abstinence. A follow‐up telephone interview was conducted for non‐responders.Results:   57 of the 116 patients had deceased. 59 with cancers in the oral cavity (n = 31), oropharynx (n = 5), paranasal sinus (n = 3), bone (n = 4), salivary gland (n = 7), skin (n = 7), and neck metastasis with unknown primary (n = 1). Of the 50 (85%) responders 37 (74%) stopped smoking, with 27 (75%) doing so around the time of diagnosis and treatment. The most influential factor for quitting smoking were the diagnosis of cancer (n = 20), hospitalisation (n = 14), medical (n = 13) and family (n = 8) advice, Quit Line (n = 2) and nicotine replacement therapy (n = 1). The latter 2 factors were ranked 6 and 5 times respectively as the least important factor. Of the 18 (49%) who quitted and restarted smoking, 5 (28%) did so within one month, 7 (39%) 1–12 months, 2 (11%) 1–5 years, and 4 (22%) at unknown interval.Conclusion:   Most patients undergoing treatment of head and neck cancer quitted smoking in response to a personal “crisis”, reinforced by the non‐smoking hospital environment and consistent medical and family advice. Strategies are needed for the high rate of restarting smoking for successful quitters.
HP01 A SURVEY OF SURGEONS ATTITUDE TO LAPAROSCOPIC LIVER RESECTIONS
Authors: Patel B. M. , O’rourke N. A. 
Published: April 2009

Introduction:   Is laparoscopic liver surgery widely performed? What are the attitudes of Australasian surgeons towards laparoscopic liver surgery?Methods:   An On‐line survey of 143 liver surgeons (all members of ANZHPBA) throughout Australia and New Zealand was performed in mid 2008.Results:   61 responses were analysed. Two were trainees, 21 fellows and 38 practicing surgeons. 50 respondents (80%) performed more than 10 open liver resections annually. 57 (90%) performed advanced laparoscopic surgery requiring suturing. 48 respondents performed laparoscopic liver resection. 30 have attempted major hepatectomy but only three of these have performed more than five. 37 surgeons have performed left lateral sectionectomy and 15 of them have performed more than 10. All but three surgeons felt that malignancy was not a contraindication to laparoscopic liver resection. The following reasons were given as deterrence stopping surgeons from more frequent laparoscopic liver resections: fear of bleeding (44%), skills not adequate (39%), time constraints (33%), availability of equipment (15%), cost of equipment (13%) and fear of gas embolism (10%). 22 (36%) have attended a laparoscopic liver resection course and 13 (55%) of them found that it influenced their attitude towards laparoscopic liver surgery.Conclusions:   Many surgeons are performing laparoscopic liver surgery for malignant conditions of the liver, but major hepatectomy is rarely performed. Fear of bleeding, time and skill constraints remain major deterrents.
HP10 POSTOPERATIVE NOMOGRAM FOR DISEASE SPECIFIC SURVIVAL AFTER SURGERY FOR OESOPHAGEAL CANCER
Authors: Thomson I. G. , Waters B. , O’rourke P. , Barbour A. , Smithers M. , Gotley D. 
Published: April 2009

Purpose:   The individual predictive ability of the current AJCC staging system for oesophageal cancer has been questioned. The ability to predict disease specific survival would enable treatment to be tailored for individual patients. The aim was to develop and validate a prognostic nomogram for disease specific survival based on patients receiving surgery alone as treatment for oesophageal cancer.Methodology:   A prospectively maintained database identified patients identified 257 patients whom underwent complete gross resection for oesophageal cancer, without adjuvant therapy, at a single institution over 20 years. Univariate analyses were performed to identify significant factors associated with disease specific survival. Subsequently a series of backward eliminations identified 5 variables as significant. Survival probabilities for each combination of prognostic factors were calculated for incorporation into the nomogram. The predictive accuracy of the nomogram was compared to the current AJCC staging system to assess for improved individual risk stratification.Results:   The median follow‐up was 35 months, the median disease specific survival was 31 months. The 5 significant prognostic factors identified were; age (>70), odynophagia, number of positive nodes (0 / 1–5 / >5), number of negative nodes (<20/20+) and pathological T stage (T1/T2/T3&4). These variables were combined in a nomogram which allowed prediction of disease specific survival.Conclusion:   Disease free survival after surgery for oesophageal cancer can be predicted using a nomogram combining age, odynophagia, number of positive nodes, number of negative nodes and T stage allowing individual risk stratification.
HP11 THE SUGSS DATABASE; A WEB BASED UPPER GI CANCER DATABASE
Authors: Smith G. S. , Minehan E. 
Published: April 2009

Purpose:   The relative infrequency of oesophago‐gastric (OG) resection for malignancy limits the generation of meaningful clinical data by single surgeons or institutions. The Sydney Upper GI Surgical Society (SUGSS) has established a secure, comprehensive internet based database of patients undergoing OG resection. The aim of this paper is to outline logistical and technical information regarding the database and present recruitment and utilisation data.Methodology:   In early 2008 general surgeons in NSW and the ACT were invited to participate in the database. The approach to recruitment was inclusive and involved presentations at local meetings and correspondence to surgeons who had previously participated in the Australian Cancer Study. Clinical, operative, pathological and follow‐up data is collected prospectively and may be entered by participating surgeons or their staff remotely or by the SUGSS data manager. Data is entered via a website and is stored on a secure server. Participating surgeons have the facility to review their own data and collective data via periodic reports generated by the website/database host.Results:   In February forty letters of invitation were sent. There were 25 responses of willingness to participate. Data entry commenced in April 2008. 20 surgeons have contributed data on a total of 122 patients, 66 oesophageal cancer, 45 gastric cancer and 11 GISTs.Conclusion:   The SUGSS database, while in its infancy has been well supported by local surgeons and may form the basis for Australasian data collection. Practical and ethical issues will be discussed.
HP16P A SYSTEMATIC APPRAISAL OF THE QUALITY OF CLINICAL GUIDELINES FOR ACUTE PANCREATITIS
Authors: Srinivasa S. , Vather R. , Loveday B. , Phillips A. , Windsor J. A. 
Published: April 2009

Purpose:   Patient management decisions are increasingly based on clinical guidelines, and guideline quality influences patient outcome. Many guidelines for the management of acute pancreatitis exist, but their quality has not been formally evaluated. This study aimed to appraise the quality of acute pancreatitis guidelines.Methodology:   A literature search identified relevant guidelines using MEDLINE, EMBASE, CINAHL and National Guidelines Clearinghouse. Two reviewers independently appraised guideline quality using three validated instruments: Grilli, Shaneyfelt and AGREE, with maximum scores of 4, 25, and 92 respectively.Results:   Thirty‐one guidelines from 1988–2008 were analysed, of which 22/31 (71%) were endorsed by official bodies and 9/31 (29%) did not have official endorsement. Twelve specialties were included in guideline development, and 21/31 (67%) guidelines involved multiple specialties. Only 8 (26%) guidelines included evidence grading. The median (range) quality scores were: Grilli, 2 (0–4); Shaneyfelt, 13 (5–23); AGREE, 59 (37–82). There was good correlation between instruments (r = 0.85–0.96, p < 0.001). Guideline quality did not increase with the year of publication (r2 = 0.05, p = 0.3). Guidelines endorsed by official bodies scored more highly than those without endorsement (AGREE 62.5 vs. 45.0, p < 0.001), while those developed by multiple specialties did not score more highly than those developed by a single specialty (AGREE 59.0 vs. 50.0, p = 0.36).Conclusion:   Current acute pancreatitis guidelines range widely in quality, and have not improved over time. Their quality is higher if endorsed by official bodies. While higher quality guidelines do not ensure better patient outcome, there is room for improvement.
HP02 LESSONS LEARNT FROM 170 LAPAROSCOPIC LIVER RESECTIONS
Authors: Hatzifotis M. , Hopkins G. , Fielding G. , Martin I. , Nathanson L. , O’rourke N. 
Published: April 2009

Introduction:   Laparoscopic liver surgery is being practiced more widely. We would like to report an experience of 170 laparoscopic liver resections.Methods:   Data was collected in a prospective fashion from five surgeons, beginning in 1997 with left lateral sectionectomy, and right hepatectomy in 1999. Parenchymal transection was effected with linear cutting staplers, harmonic shears, and most recently, the Ligasure bipolar device.Results:   We attempted 27 major resections, 63 sectionectomies, and 80 minor resections. Only rarely were procedures hand‐assisted, or “hybrid”. The conversion rate was 8%. Median blood loss was 250 ml. (Range 0–41) Median operative time was 120 minutes. Fifty‐one percent of resections were for malignancy. Margins were positive in 5 patients. The overall post operative morbidity was 12%. There were 4 bile leaks. There was one death.Discussion:  The indications for surgery should be the same as for open liver resection, however tempting it may be to offer definitive diagnosis by removing peripheral, probably benign, lesions. Approximately 20% of our liver resections are attempted laparoscopically. Most left lateral sectionectomies are performed this way. Major hepatectomies should be attempted only if the tumour is well clear of the plane of transection. Non‐anatomic resections require intraoperative ultrasound to ensure adequate margins and to identify large vessels. The ability to suture laparoscopically is essential.Conclusion:   The evolving technology of parenchymal transection devices makes laparoscopic liver surgery an exciting frontier. Surgeons must be skilled in open liver surgery and advanced laparoscopy before attempting more than the simplest of procedures.
HP22P INTRA‐OPERATIVE MAPPING OF HUMAN GASTRIC SLOW WAVE ACTIVITY: INITIAL RESULTS
Authors: O’grady G. , Du P. , Lammers W. J. , Cheng L. K. , Pullan A. J. , Windsor J. A. 
Published: April 2009

Purpose:   The stomach has an underlying slow wave activity that coordinates contractions. Human gastric slow wave activity is poorly understood, as existing descriptions rely on recordings from very few sites (typically ≤4). We aim to develop an improved description, in order to guide diagnostic and therapeutic strategies for dysmotility syndromes, such as post‐operative delays in gastric emptying.Methodology:   Two novel electrode platforms were developed and validated for this study: a high‐resolution flexible printed circuit board (PCB) array (4 × 8 electrodes), and a laparoscopic device (2 × 2). Five patients have undergone intraoperative gastric mapping to date, using up to 6 tessellated PCBs (total of 192 electrodes; 96 cm2). Signals were recorded using the ActiveTwo System (Biosemi, Netherlands).Results:   Slow wave frequencies were 2.85 ± 0.18 cycles per minute, with at least 3 distinct slow wave fronts being simultaneously active. Compared to corpus activity, antral activity was of greater amplitude (0.10 ± 0.03 mV vs. 0.04 ± 0.01 mV) and higher velocity (7.4 ± 1.1 mm s<συπ>−1<?συπ> vs. 2.8 ± 0.8 mm s<συπ>−1<?συπ>), with a sharp transition between regions. Isochronal mapping showed consistent aboral propagation. A relatively high amplitude / high velocity pacemaker area was localised high along the greater curvature.Conclusion:   Initial mapping results suggest the need to revise existing descriptions of human gastric slow wave activity. The findings of multiple synchronous slow wave fronts, sharp regional variations in slow wave characteristics, and a high‐amplitude pacemaker zone need to be confirmed in a larger cohort of patients before the physiological, pathophysiological, diagnostic and therapeutic implications can be fully understood.
HP24P LAPAROSCOPIC LEFT LATERAL SECTIONECTOMY – CONTROLLING INDICATIONS AND AVOIDING PITFALLS
Authors: Hatzifotis M. , Patel B. , Fielding G. , Martin I. , Nathanson L. , O’rourke N. 
Published: April 2009

Introduction:   Laparoscopic left lateral sectionectomy has been described as the gold standard and is the most frequently performed laparoscopic liver resection, particularly early in ones experience. This operation can be very simple and quick but there remains the potential for significant morbidity and even mortality. The laparoscopic approach should not significantly broaden the indications for surgery.Methods:   This paper reports a consecutive series of 60 laparoscopic left lateral sectionectomies. We describe our technique which avoids any formal dissection of inflow or outflow. The mobilized left lateral section is separated from the liver using multiple firings of a linear cutting stapler device, in one, two, or occasionally three layers for bulky livers.Results:   The median procedure time was 90 min (30–310 min). Median blood loss was 200 ml (0–1400 ml), with six patients requiring laparoscopic suturing. There were 3 conversions, with one for bleeding. Sixty percent of lesions were benign, reflecting early enthusiasm and referral bias. However in the last two years all lesions removed have been malignant. Median length of hospital stay was 4 days (1–19). Our overall morbidity was 15%. There was one post operative death.Conclusion:   This approach offers all the benefits of laparoscopic surgery. Despite these good results we have still had significant problems and recommend strongly that it should only be performed by experienced liver surgeons, also skilled in laparoscopic surgery. The ability to suture laparoscopically is essential, and one must not view conversion as a technical failure. The indications for surgery should not be broadened.
HP26P MANAGEMENT OF PERFORATED GASTRIC ULCERS IN A SYDNEY TERTIARY REFERRAL CENTRE
Authors: Vanguru V. R. , Suen M. , Hollands M. , Richardson A. , Pleass H. , Lam V. 
Published: April 2009

Background:   Traditional surgical teaching recommends partial gastrectomy rather than omental patch repair for the management of perforated gastric ulcer. This study analysed the outcome of these two operative procedures in a tertiary referral centre.Methods:   A retrospective analysis of a prospective collected database was performed on all patients who presented to Westmead Hospital with perforated gastric ulcer between January 1992 and December 2008.Results:   All 21 patients with perforated gastric ulcers underwent surgical management. Omental patch repair was performed in 15 patients (71%) and 6 patients (29%) underwent a partial gastrectomy. There was no significant difference in premorbid illnesses and risk factors other than smoking being higher in the omental patch repair group (p = 0.02). The operating time was significantly lower in the omental patch repair group compared to that of partial gastrectomy group (87 minutes versus 150 minutes; p = 0.02). Partial gastrectomies were performed more often when the consultant surgeons were performing the surgery (p = 0.04). The overall mortality rate was 14% with no significant difference in mortality rate between the two groups. (1/6 versus 2/16; p = 0.84). Omental patch repair group had a significantly lower (p = 0.04) morbidity rate compared to partial gastrectomy group (53% versus 100%; p = 0.04). None of these patients had malignant perforated gastric ulcers.Conclusion:   Perforated gastric ulcer is uncommon. Omental patch repair was associated with faster operating time, lower morbidity rate and similar mortality rate compared to that of partial gastrectomy. Omental patch repair merits consideration as the first line therapy in patients with perforated gastric ulcer.
HP28P MINIMALLY INVASIVE MANAGEMENT OF PANCREATIC ABSCESS, PSEUDOCYST AND NECROSIS: A SYSTEMATIC REVIEW OF CURRENT GUIDELINES
Authors: Loveday B. , Mittal A. , Phillips A. , Windsor J. A 
Published: April 2009

Purpose:   Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although no randomised trials exist to evaluate these techniques. This study aims to review the scope and quality of recommendations in current clinical guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis; and identify the degree of consensus between guidelines.Methodology:   A MEDLINE search identified current guidelines published in English from any professional body. Guidelines were analysed to determine their recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected necrosis.Results:   Sixteen guidelines were reviewed. Percutaneous catheter drainage was recommended by eight guidelines for pancreatic abscess; for infected pseudocysts, one guideline did not recommend its use, and six recommended its use; for infected necrosis, two guidelines did not recommend its use, and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations.Conclusion:   Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst and infected necrosis, and few recommendations included evidence grading. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.
HP29P SIGNIFICANT IMPACT OF 18F‐FDG‐PET ON THE DIAGNOSTIC EVALUATION AND TREATMENT OF NEWLY DIAGNOSED OESOPHAGEAL CANCER
Authors: Aly A. , Azad A. , Koh S. , Gibson R. , Pendulbury A. 
Published: April 2009

Background:   Accurate staging of newly diagnosed oesophageal cancer is important for optimising management. Previous studies have demonstrated that FDG‐PET scanning can alter management by upstaging patients with newly diagnosed oesophageal cancer. However, few studies have evaluated whether the use of PET alters management by downstaging patients and have also not considered the impact of PET upon the diagnostic evaluation process itself. Furthermore, most data comes from the pre multidisciplinary team (MDT) era and may not be relevant currently where co‐ordinated standardised approaches are more common. We aimed to evaluate the potential impact of PET upon the diagnostic, staging and treatment pathways in an MDT setting by applying a standardised algorithm.Methods:   We retrospectively reviewed 34 consecutive patients undergoing PET during staging for newly diagnosed oesophageal cancer at Austin Health between 2002 and 2007. PET scans were reviewed by an experienced nuclear medicine physician blinded to clinical outcome. Cases were evaluated using a standard algorithm with and without PET scanning to determine potential differences in management.Results:   Discordance between pre‐PET imaging and PET was identified in 13 of 34 (38%) patients. PET changed the stage classification in 11 of 34 (32%) of patients, including three patients with oligometastatic disease on pre‐PET staging. PET changed diagnostic evaluation in 5 of 34 (15%) and altered management in 7 of 34 (21%) patients.Conclusion:   Incorporating PET into the staging of newly diagnosed oesophageal cancer had a major impact on stage classification, diagnostic evaluation and management.