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Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM. The provision of general surgery in rural Australia: a narrative review. Med J Aust 2024; 220:258-263. [PMID: 38357826 DOI: 10.5694/mja2.52232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural-facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.
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Affiliation(s)
- Jessica Paynter
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Kirby R Qin
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Janelle Brennan
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
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Peri V, Lee E, Fink M, Starkey G, Nikfarjam M, Yoshino O, Furtado R, Sinclair M, Testro A, Majumdar A, Jones R, Muralidharan V, Perini MV. A Single Centre Experience with Pre-Operative Markers in the Prediction of Outcomes after Liver Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2023; 27:1376-1386. [PMID: 37095335 DOI: 10.1007/s11605-023-05681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/08/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM The C-reactive protein to albumin ratio, albumin-bilirubin index and platelet-albumin-bilirubin index have emerged as prognostic scores in hepatocellular carcinoma, although their clinical utility remains unclear, with ongoing investigation in multiple patient populations. This study aims to report survival outcomes and evaluate these indices in a cohort of patients undergoing liver resection for hepatocellular carcinoma in a tertiary Australian centre. METHODS This retrospective study reviewed data from the Department of Surgery at Austin Health and electronic health records (Cerner corporation). The impact of pre, intra and post-operative parameters on post-operative complications, overall and recurrence free survival were analyzed. RESULTS 163 liver resections were performed in 157 patients between 2007 and 2020. Post-operative complications occurred in 58 patients (35.6%), with pre-operative albumin < 36.5 g/L (3.41(1.41-8.29),p = 0.007) and open liver resection (3.93(1.38-11.21),p = 0.011) demonstrating independent predictive significance. 1,3 and 5-year overall survival was 91.0%, 76.7% and 66.9% respectively, with a median survival time of 92.7 months (81.3-103.9). Hepatocellular carcinoma recurred in 95 patients (58.3%) with a median time to recurrence of 27.8 months (15.6-39.9). 1,3 and 5 year recurrence-free survival rates were 94.0%, 73.7% and 55.1% respectively. Pre-operative C-reactive protein-albumin ratio > 0.034 was significantly associated with reduced overall (4.39(1.19-16.16),p = 0.026) and recurrence-free (2.53(1.21-5.30),p = 0.014) survival. CONCLUSION C-reactive protein-albumin ratio > 0.034 is a strong predictor of poor prognosis following liver resection for hepatocellular carcinoma. In addition, pre-operative hypoalbuminemia was associated with post-operative complications, and future studies are required to assess the potential benefits of albumin replacement in reducing post-surgical morbidity.
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Affiliation(s)
- Varun Peri
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
| | - Eunice Lee
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Graham Starkey
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Osamu Yoshino
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Ruelan Furtado
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Marie Sinclair
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Avik Majumdar
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Marcos Vinicius Perini
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia.
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia.
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