29 results found
Byrne BE, Harrison-Phipps K, Ong C, et al., 2020, Tracheal and left bronchial-oesophageal fistula repair and salvage 3-phase oesophagectomy supported by extra-corporeal membrane oxygenation: A case report, Annals of Esophagus, Vol: 3
We present the first report of salvage oesophagectomy for complicated airway-oesophageal fistula disease supported by perioperative veno-venous extracorporeal membrane oxygenation (ECMO). A 47-year-old female underwent definitive chemoradiotherapy for a locally advanced T4N0M0 oesophageal squamous cell carcinoma. During treatment, worsening dysphagia was treated with an oesophageal stent. She then presented with dysphagia and pneumonia, and was referred to our unit with two airway-oesophageal fistulae secondary to oesophageal stent insertion. After ruling out local or systemic recurrence, the patient underwent salvage 3-phase oesophagectomy. Treatment was planned and performed by a multi-disciplinary team (MDT) of anaesthetists, intensivists, thoracic and oesophago-gastric surgeons. Total gas exchange was maintained using ECMO, allowing discontinuation of mechanical ventilation for right thoracotomy and repair of the trachea and left main bronchus with intercostal muscle flaps. Intestinal continuity was restored with a retrosternal gastric conduit. The patient was extubated on the day of surgery and was weaned off ECMO by postoperative day 6. Slow postoperative recovery was complicated by re-intubation for 4 days for respiratory failure. Oral intake improved after pyloric dilation and the patient was discharged on postoperative day 40. Histological examination confirmed no residual malignancy. At 20 weeks post discharge, the patient is eating a normal diet, her weight is stable, and she has returned to full-time work. Elective ECMO support may facilitate safe oesophagectomy in the presence of airway-oesophageal fistula in carefully selected patients.
Byrne BE, Faiz OD, Bottle A, et al., 2020, A Protocol is not Enough: Enhanced Recovery Program-Based Care and Clinician Adherence Associated with Shorter Stay After Colorectal Surgery, WORLD JOURNAL OF SURGERY, Vol: 45, Pages: 347-355, ISSN: 0364-2313
Knight WRC, McEwen R, Byrne BE, et al., 2020, Endoscopic tumour morphology impacts survival in adenocarcinoma of the oesophagus, European Journal of Surgical Oncology, ISSN: 0748-7983
BackgroundPrognostication in oesophageal cancer on the basis of preoperative variables is challenging. Many of the accepted predictors of survival are only derived after surgical treatment and may be influenced by neoadjuvant therapy. This study aims to explore the relationship between pre-treatment endoscopic tumour morphology and postoperative survival.MethodsPatients with endoscopic descriptions of tumours were identified from the prospectively managed databases including the OCCAMS database. Tumours were classified as exophytic, ulcerating or stenosing. Kaplan Meier survival analysis and multivariable Cox regression analyses were performed to determine hazard ratios (HR) with 95% confidence intervals.Results262 patients with oesophageal adenocarcinoma undergoing potentially curative resection were pooled from St Thomas’ Hospital (161) and the OCCAMS database (101). There were 70 ulcerating, 114 exophytic and 78 stenosing oesophageal adenocarcinomas. Initial tumour staging was similar across all groups (T3/4 tumours 71.4%, 70.2%, 74.4%). Median survival was 55 months, 51 months and 36 months respectively (p < 0.001). Rates of lymphovascular invasion (P = 0.0176), pathological nodal status (P = 0.0195) and pathological T stage (P = 0.0007) increased from ulcerating to exophytic to stenosing lesions. Resection margin positivity was 21.4% in ulcerating tumours compared to 54% in stenosing tumours (p < 0.001). When compared to stenosing lesions, exophytic and ulcerating lesions demonstrated a significant survival advantage on multivariable analysis (HR 0.56 95% CI 0.31–0.93, HR 0.42 95% CI 0.21–0.82).ConclusionThis study demonstrates that endoscopic morphology may be an important pre-treatment prognostic factor in oesophageal cancer. Ulcerating, exophytic and stenosing tumours may represent different pathological processes and tumour biology.
Byrne BE, Rooshenas L, Lambert HS, et al., 2020, A mixed methods case study investigating how randomised controlled trials (RCTs) are reported, understood and interpreted in practice, BMC MEDICAL RESEARCH METHODOLOGY, Vol: 20
Reeves BC, Rooshenas L, Macefield RC, et al., 2019, Three wound-dressing strategies to reduce surgical site infection after abdominal surgery: the Bluebelle feasibility study and pilot RCT., Health Technol Assess, Vol: 23, Pages: 1-166
BACKGROUND: Surgical site infection (SSI) affects up to 20% of people with a primary closed wound after surgery. Wound dressings may reduce SSI. OBJECTIVE: To assess the feasibility of a multicentre randomised controlled trial (RCT) to evaluate the effectiveness and cost-effectiveness of dressing types or no dressing to reduce SSI in primary surgical wounds. DESIGN: Phase A - semistructured interviews, outcome measure development, practice survey, literature reviews and value-of-information analysis. Phase B - pilot RCT with qualitative research and questionnaire validation. Patients and the public were involved. SETTING: Usual NHS care. PARTICIPANTS: Patients undergoing elective/non-elective abdominal surgery, including caesarean section. INTERVENTIONS: Phase A - none. Phase B - simple dressing, glue-as-a-dressing (tissue adhesive) or 'no dressing'. MAIN OUTCOME MEASURES: Phase A - pilot RCT design; SSI, patient experience and wound management questionnaires; dressing practices; and value-of-information of a RCT. Phase B - participants screened, proportions consented/randomised; acceptability of interventions; adherence; retention; validity and reliability of SSI measure; and cost drivers. DATA SOURCES: Phase A - interviews with patients and health-care professionals (HCPs), narrative data from published RCTs and data about dressing practices. Phase B - participants and HCPs in five hospitals. RESULTS: Phase A - we interviewed 102 participants. HCPs interpreted 'dressing' variably and reported using available products. HCPs suggested practical/clinical reasons for dressing use, acknowledged the weak evidence base and felt that a RCT including a 'no dressing' group was acceptable. A survey showed that 68% of 1769 wounds (727 participants) had simple dressings and 27% had glue-as-a-dressing. Dressings were used similarly in elective and non-elective surgery. The SSI questionnaire was developed from a content analysis of existing SSI tools and interviews, yielding 19
Archer SA, Pinto A, Vuik S, et al., 2019, Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors, Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932
Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.
Byrne BE, Rooshenas L, Lambert H, et al., 2018, Evidence into practice: protocol for a new mixed-methods approach to explore the relationship between trials evidence and clinical practice through systematic identification and analysis of articles citing randomised controlled trials, BMJ OPEN, Vol: 8, ISSN: 2044-6055
Byrne BE, Vincent CA, Faiz OD, 2018, Inequalities in Implementation and Different Outcomes During the Growth of Laparoscopic Colorectal Cancer Surgery in England: A National Population-Based Study from 2002 to 2012, WORLD JOURNAL OF SURGERY, Vol: 42, Pages: 3422-3431, ISSN: 0364-2313
Byrne BE, Bassett M, Rogers CA, et al., 2018, Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study., BMJ Open, Vol: 8, ISSN: 2044-6055
OBJECTIVES: This study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement. DESIGN: National cohort study using National Emergency Laparotomy Audit (NELA) data. SETTING: English and Welsh hospitals within the National Health Service. PARTICIPANTS: Adult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015. INTERVENTIONS: Laparotomy for bleeding or perforated peptic ulcer. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate. RESULTS: 2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7-17) and 2 (1-3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach. CONCLUSIONS: Patients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent an
Byrne BE, Rogers CA, Blazeby JM, 2018, The end of bursectomy for gastric cancer?, LANCET GASTROENTEROLOGY & HEPATOLOGY, Vol: 3, Pages: 446-447, ISSN: 2468-1253
Main BG, Blencowe NS, Howes N, et al., 2018, Protocol for the systematic review of the reporting of transoral robotic surgery, BMJ OPEN, Vol: 8, ISSN: 2044-6055
Byrne BE, Pinto A, Aylin P, et al., 2015, Understanding how colorectal units achieve short length of stay: an interview survey among representative hospitals in England, Patient Safety in Surgery, Vol: 9
Byrne BE, Faiz OD, Vincent C, 2015, Do patients with gastrointestinal cancer want to decide where they have tests and surgery? A questionnaire study of provider choice., BMJ Quality & Safety, Vol: 25, Pages: 696-703, ISSN: 2044-5423
BACKGROUNDS: Choice of provider has been an important strategy among policy makers, intended, in part, to drive improvements in quality and efficiency of healthcare. This study examined the information requirements, and decision-making experiences and preferences of patients who have had surgery for gastrointestinal cancer, to assess the status of provider choice in current practice. METHODS: The single-item Control Preferences Scale was used to determine patients' experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, processes and outcomes at the hospital level and the department level. Participants were recruited by post and online. RESULTS: 463 responses were analysed. Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice than they experienced. Of note, patient age and education were not associated with reported preferences. Information on how long patients with cancer wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important. CONCLUSIONS: There was a substantial unmet desire for greater involvement in provider choice among study participants. Respondents attached particular importance to surgery-specific information. Efforts should be made to increase involvement of patients with gastrointestinal cancer in provider decisions, across primary and secondary care, to deliver more patient-centred care. The reported lack of patient involvement in provider choice suggests it is unlikely to be working as an effective lever to drive quality improvement at present.
Byrne BE, Faiz O, Darzi AW, et al., 2015, Do Gastrointestinal Cancer Patients Want to Decide Where They Have Tests and Surgery? A Questionnaire Study of Provider Choice and Information Needs, 70th Annual Sessions of the Scientific Forum and Annual Clinical Congress of the American-College-of-Surgeons, Publisher: Elsevier, Pages: S138-S139, ISSN: 1072-7515
Byrne BE, Vincent CA, Stebbing J, et al., 2015, FALLING EMERGENCY OPERATION RATES AND REDUCED MORTALITY AFTER COLON CANCER SURGERY IN ENGLAND: A COHORT STUDY, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A339-A340, ISSN: 0017-5749
Introduction Recent years have seen many changes within colorectal surgery. Laparoscopic techniques, fast track management, and bowel cancer screening have become widespread. This study examined changes in surgical treatment and outcomes for colon cancer over time against background registration rates, with subgroup analysis by urgency and age.Method Annual data on colon cancer registrations and population size was obtained. Administrative data were used to identify adults undergoing colonic resection for cancer in England between April 1998 and March 2012. Cancer registrations, treatment and mortality rates were age-standardised. The proportion of registrations undergoing surgery was examined, and subgroups were analysed by urgency of admission and age group. Temporal trends were assessed using the Joinpoint Regression Program (National Cancer Institute, USA).Results The standardised rate of colon cancer registration rose from 27.1 to 29.1 per 100 000 population. The proportion of registrations undergoing surgery fell, from approximately 67% to 57% (Annual Percentage Change = −1.44, p < 0.05), due to a significant fall in non-elective operating; the elective treatment rate did not change. Postoperative 90-day mortality rates fell across all age groups for elective and non-elective surgery, from approximately 6.5% to 3% and 19% to 13%, respectively.Conclusion Colon cancer registrations increased over time. The surgical treatment rate per colon cancer fell, due to falling rates of non-elective surgery. Possible explanations include improved early detection of colon cancer, changes in case selection, and improvements in non-surgical treatments. Postoperative mortality fell significantly after elective and non-elective surgery for all age groups. Considered together, these findings suggest a global improvement in the quality of surgical care for colon cancer. Future studies should include non-surgical treatments with information on stage of cancer at presentat
Pannick S, Davis R, ashrafian H, et al., 2015, Effects of interdisciplinary team care interventions on general medical wards. A systematic review., JAMA Internal Medicine, Vol: 175, Pages: 1288-1298, ISSN: 2168-6114
Importance Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams’ performance improves patient outcomes in other settings, and interdisciplinary practice is a major target for improvement efforts. However, the effect of interdisciplinary team interventions on general medical ward care has not been systematically reviewed.Objectives To describe the range of objective patient outcomes used in studies of general medical ward interdisciplinary team care, and to evaluate the performance of interdisciplinary interventions against them.Evidence Review We searched EMBASE, MEDLINE, and PsycINFO from January 1, 1998, through December 31, 2013, for interdisciplinary team care interventions in adult general medical wards using an objective patient outcome measure. Reference lists of included articles were also searched. The last search was conducted on January 29, 2014, and the narrative and statistical analysis was conducted through December 1, 2014. Study quality was assessed using the Cochrane Effective Practice and Organization of Care group’s tool.Findings Thirty of 6934 articles met the selection criteria. The studies included 66 548 patients, with a mean age of 63 years. Nineteen of 30 (63%) studies reported length of stay, readmission, or mortality rate as their primary outcome, or did not specify the primacy of their outcomes. The most commonly reported objective patient outcomes were length of stay (23 of 30 [77%]), complications of care (10 of 30 [33%]), in-hospital mortality rate (8 of 30 [27%]), and 30-day readmission rate (8 of 30 [27%]). Of 23 interventions, 16 (70%) had no effect on length of stay, 12 of 15 (80%) did not reduce readmissions, and 14 of 15 (93%) did not affect mortality. Five of 10 (50%) interventions reduced complications of care. In an exploratory quantitative analysis, the
Byrne BE, Faiz OD, Darzi A, et al., 2015, Do gastrointestinal cancer patients want to decide where they have tests and surgery? a questionnaire study of provider choice and information needs, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A119-A120, ISSN: 0017-5749
Introduction Choice of provider has been an important strategy among policy makers over recent years, intended, in part, to drive improvements in quality and efficiency of health care. Provider choice has been relatively under-studied among patients with cancer, compared with benign disease. This study examines decision-making experiences, preferences and information needs among patients who have had surgery for gastrointestinal cancer.Method This questionnaire study used the single-item Control Preferences Scale to determine patients’ experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, process and outcomes at hospital- and department-level. Participants were recruited by post and online.Results 463 responses were included. Where indicated, 334 of 415 (80.5%) respondents had upper gastrointestinal cancer. Postal response rates were higher than online (47.2% vs 23.1%,p < 0.001). Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice. Information on how long cancer patients wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important.Conclusion There is a substantial unmet desire for greater involvement in provider choice among gastrointestinal cancer patients. Participants in this study attached particular importance to surgery-specific information. Improving involvement and information provision will require a coordinated approach in both primary and secondary care. Greater involvement in decision-making may increase satisfaction and contribute to a greater sense of control among these patien
Byrne BE, Aylin P, Bottle A, et al., 2015, PTU-269 Lack of engagement in surgical quality improvement research is associated with poorer quality of care, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ Publishing Group, Pages: A179-A180, ISSN: 0017-5749
Byrne B, Aylin P, Bottle R, et al., 2015, Lack of engagement in surgical quality improvement research is associated with poorer quality of care., Digestive Disorders Federation
Byrne B, Faiz O, Darzi A, et al., 2015, Do gastrointestinal cancer patients want to decide where they have tests and surgery? A questionnaire study., Digestive Disorders Federation
Byrne B, Aylin P, Bottle RA, et al., 2015, Failure to engage in surgical quality improvement research is associated with poorer quality of care, Royal Society of Medicine, Coloproctology section: Overseas meeting in Leuven
Byrne BE, Mamidanna R, Vincent CA, et al., 2014, Outlier Identification in Colorectal Surgery Should Separate Elective and Nonelective Service Components, DISEASES OF THE COLON & RECTUM, Vol: 57, Pages: 1098-1104, ISSN: 0012-3706
Byrne B, Mamidanna R, Vincent CA, et al., 2014, Variation in outcomes between elective and non-elective colorectal surgery: a population-based cohort study., Digestive Diseases Week
Byrne BE, Mamidanna R, Vincent CA, et al., 2013, Variation in outcomes between elective and non-elective colorectal surgery: a population-based cohort study., Royal Society of Medicine, Coloproctology Section: John of Arderne medal short papers session
Introduction: The outcomes of elective and non-elective colorectal surgery differ significantly but are often studied together. This study compares the characteristics and outcomes of patients undergoing elective and non-elective colorectal surgery in England.Methods: Adult patients undergoing major colorectal resection between April 2001 and February 2007 in English National Health Service Trusts were identified from administrative data. 90-day mortality was determined using statutory records of death. Case-mix adjusted Trust-level mortality was calculated using multivariate logistic regression. High and low mortality outliers were compared across funnel plots for elective and non-elective surgery.Results: 171 330 patients, treated at 151 English Trusts, were included. 90-day mortality rates for elective and non-elective surgery were 5.6% and 22.2%, respectively. Elective and non-elective cohorts were statistically significantly different for all characteristics. No unit with high outlying mortality for elective surgery was a high outlier for non-elective mortality, and vice-versa. Trust-level, observed-to-expected mortality for elective and non-elective surgery was moderately correlated (Spearman’s rho, ρ=0.501, p<0.001).Conclusions: The patients, procedures and outcomes for elective and non-elective surgery were different. The authors suggest elective and non-elective outcomes should be studied and reported separately. High absolute mortality after non-elective surgery highlights its importance for further study and quality improvement.
Byrne BE, Mamidanna R, Vincent CA, et al., 2013, Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery., British Journal of Surgery, Vol: 100, Pages: 1810-1817
BACKGROUND:Surgical mortality results are increasingly being reported and published in the public domain as indicators of surgical quality. This study examined how mortality outlier status at 90 days after colorectal surgery compares with mortality at 30 days and subsequent intervals in the first year after surgery.METHODS:All adults undergoing elective and emergency colorectal resection between April 2001 and February 2007 in English National Health Service (NHS) Trusts were identified from administrative data. Funnel plots of postoperative case mix-adjusted institutional mortality rate against caseload were created for 30, 90, 180 and 365 days. High- or low-mortality unit status of individual Trusts was defined as breaching upper or lower third standard deviation confidence limits on the funnel plot for 90-day mortality.RESULTS:A total of 171 688 patients from 153 NHS Trusts were included. Some 14 537 (8·5 per cent) died within 30 days of surgery, 19 466 (11·3 per cent) within 90 days, 23 942 (13·9 per cent) within 180 days and 31 782 (18·5 per cent) within 365 days. Eight institutions were identified as high-mortality units, including all four units with high outlying status at 30 days. Twelve units were low-mortality units, of which six were also low outliers at 30 days. Ninety-day mortality correlated strongly with later mortality results (rs = 0·957, P < 0·001 versus 180-day mortality; rs = 0·860, P < 0·001 versus 365-day mortality).CONCLUSION:Extending mortality reporting to 90 days identifies a greater number of mortality outliers when compared with the 30-day death rate. Ninety-day mortality is proposed as the preferred indicator of perioperative outcome for local analysis and public reporting.
Byrne BE, Mamidanna R, Vincent CA, et al., 2013, Examining the impact of using 90-day rather than 30-day mortality rates for identifying poor performing surgical providers in colorectal surgery: a population-based cohort study., European Society of Coloproctology, Publisher: Wiley, Pages: 1-129
Introduction: Surgical outcomes are increasingly reported in the public domain. This study examines how 90-day institutional mortality outlier status compares with 30-day status and later periods up to one year after colorectal surgery.Method: Adult patients undergoing colorectal resection between April 2001 and February 2007 in English NHS Trusts were identified from administrative data. Funnel plots of postoperative case-mix adjusted institutional mortality rate against caseload were created for 30, 90, 180, and 365 days. Mortality outlier status (outside third standard deviation control limits) was examined across time periods.Results: 171 688 patients were included. At 90 days eight institutions were identified as high outliers, including all four units with high outlying status at 30 days. 12 providers were low outliers at 90 days, of which six were also low outliers by 30 days. 90-day mortality performance correlated strongly with later mortality results up to one year.Conclusions: Examining mortality at 90 days identified a greater number of outliers than 30-day results. This may allow detection of the delayed effects of perioperative care while retaining the ability to identify early outlying units. 90-day mortality is proposed as the preferred indicator of the quality of perioperative care for performance analysis.
Byrne BE, Branagan G, Chave HS, 2013, Unselected rectal cancer patients undergoing low anterior resection with defunctioning ileostomy can be safely managed within an Enhanced Recovery Programme, TECHNIQUES IN COLOPROCTOLOGY, Vol: 17, Pages: 73-78, ISSN: 1123-6337
Byrne BE, Cutress RI, Gill J, et al., 2012, The Axillary Nodal Harvest in Breast Cancer Surgery Is Unchanged by Sentinel Node Biopsy or the Timing of Surgery, International Journal of Breast Cancer, Vol: 2012, ISSN: 2090-3189
Introduction. Patients with a positive sentinel lymph node biopsy may undergo delayed completion axillary dissection. Where intraoperative analysis is available, immediate completion axillary dissection can be performed. Alternatively, patients may undergo primary axillary dissection for breast cancer, historically or when preoperative assessment suggests axillary metastases. This study aims to determine if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods. Three consecutive comparable groups of 50 consecutive patients who underwent axillary dissection in each of the above contexts were identified from the Portsmouth Breast Unit Database. Patient demographics, clinicopathological variables, and surgical treatment were recorded. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results. There were no differences in clinico-pathological features between the three groups for all features studied with the exception of breast surgical procedure (P < 0.001). There were no differences in total nodal harvest (P = 0.822) or in the number of positive nodes harvested (P = 0.157) between the three groups. Conclusion. The three approaches to axillary clearance yield equivalent nodal harvests, suggesting oncological equivalence and robustness of surgical technique.
Byrne BE, Geddes T, Welsh FKS, et al., 2012, The incidence and outcome of brain metastases after liver resection for colorectal cancer metastases, COLORECTAL DISEASE, Vol: 14, Pages: 721-726, ISSN: 1462-8910
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