Retroperitoneal sarcomas are a rare and heterogenous group of tumours. There is increasing evidence that high volume sarcoma units achieve superior outcomes than low volume units. Due to the relatively small population, New Zealand is unlikely to generate a sufficient case volume to be considered high volume. To our knowledge, no well-established key performance indicators (KPIs) exist for retroperitoneal sarcoma surgery. In order to ensure quality standards we aim to propose KPIs which will act as a benchmark and a target for future quality improvement.Potential KPIs were generated by internal discussion within the sarcoma team, taking into consideration available guidelines and evidence. Cases treated through the unit since 2015 were audited to determine historical performance against these KPIs.Eighty-six patients with primary retroperitoneal sarcomas were identified. 69% of patients were discussed at the sarcoma MDM prior to treatment, 62% underwent preoperative core biopsy. 82% of patients were seen and treated within target timeframes set by the Ministry of Health. 53% of patients underwent surgery with a sarcoma trained surgeon. R0/R1 rate was 88%. 90-day mortality was 4.6%.Surgical treatment of retroperitoneal sarcomas is complex and can be associated with significant morbidity. The proposed KPIs provide a measure of service performance and provide targets for quality improvement.
With better understanding of disease biology and technological advances, an increasing number of gastric gastrointestinal stromal tumors (GISTs) are being resected laparoscopically. We assessed our management of gastric GISTs in our institution.Prospectively collected data from 13 patients who underwent surgery for gastric gastrointestinal stromal tumors over an 18-month period were analyzed with respect to operative and oncological outcomes. Seven patients underwent open resection and 6 patients had laparoscopic resection.The tumors were evenly distributed in both groups in whom the median age was 68 years in the open group vs. 70 years in the laparoscopic group. The median operating time was 132 min in the open group and 110 min in the laparoscopic group and patients who had a laparoscopic resection had a shorter hospital stay (4 days versus 11 days). Patients in the open group had a larger tumor the patients in the laparoscopic group (11.5 x 6 x 4 cm vs. 5 x 4 x 3 cm). No patient had evidence of recurrence at median follow-up of 9 months.Patients with small gastric GISTs can be safely resected with a laparoscopic approach, offering a quicker operation and shorter hospital stay. A laparoscopic approach does not alter risk of early local or distant recurrence.
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.
Subspecialization of vascular surgery and the advent of endovascular techniques for aortic aneurysm repair have had a large impact on the approach to aortic surgery in main centres. Centralization of vascular surgery has been proposed to lower mortality and morbidity rates. More recently, clinical governance standards have been set by professional bodies for acceptable adverse outcome rates in aortic surgery. A peripheral general surgeon's experience with aortic surgery is reviewed in the present report in order to identify the local adverse outcome rates, and to relate them to case data and governance recommendations.A retrospective audit of 100 cases of elective and emergency aortic aneurysm repair (performed by the senior author over a 10-year period) was undergone for the present review. Demographic and outcome data were recorded, and a data analysis was performed to identify factors related to mortality. Significance was tested using chi-squared analysis.Postoperative mortality rates were 1.7% for elective cases and 21% for acute cases. Mortality was related to rupture of the aneurysm, blood loss and American Society of Anesthetists score > 3.Morbidity and mortality rates from this audit compare favourably with those from larger vascular units. They are well within the accepted clinical governance rates, although the latter do not account for any case mix variation which may exist between peripheral and tertiary referral centres. These results support the continuation of aortic aneurysm surgery in peripheral centres.
Purpose Management of nodal disease in papillary thyroid cancer (PTC) varies. The significance of micrometastases and their relationship to locoregional recurrence has not been well described. We set out to compare patients with micrometastatic nodal disease to those with macrometastases and those with no metastases. Our service follows a policy of routine central/recurrent nerve dissection and ipsilateral jugulocarotid node sampling for cases of PTC. Methodology One hundred and seventy patients who had surgery for PTC between January 1995 and December 2000 were included and split into three groups. Micrometastases (only micrometastatic disease), Macrometastases (any macrometastaic nodal involvement) and No metastases (absence of any nodal involvement). These three groups were compared for rates of locoregional disease recurrence and distant metastases. Results Contingency analysis showed that the Macrometastases group had a significantly higher rate of locoregional recurrence compared with both No metastases(Odds ratio 7.67, p < 0.0001) and Micrometastases groups (Odds ratio 9.212, p 0.0154). There was no difference between the No metastases and micrometastases groups (p 1.000), the p value suggesting the two groups were likely to be equivalent. Analysis revealed that distant disease was significantly more common in the Macrometastases group when compared to the No metastases group, (Odds ratio 25.09, p 0.0032) Conclusions Micrometastatic nodal disease associated with PTC does not lead to higher rates of locoregional recurrence or distant disease. These patients do not need completion neck dissection and have a low risk of locoregional recurrence.
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