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Saw KS, Sexton K, Frankish P, Hulme-Moir M, Bissett I, Parry S. Interval colorectal cancers after negative faecal immunochemical test in the New Zealand Bowel Screening Pilot. BMJ Open Gastroenterol 2023; 10:e001233. [PMID: 38007223 PMCID: PMC10679982 DOI: 10.1136/bmjgast-2023-001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE Evaluate the diagnostic performance of faecal immunochemical test (FIT), identify risk factors for FIT-interval colorectal cancers (FIT-IC) and describe long-term outcomes of participants with colorectal cancers (CRC) in the New Zealand Bowel Screening Pilot (BSP). DESIGN From 2012 to 2017, the BSP offered eligible individuals, aged 50-74 years, biennial screening using a quantitative FIT with positivity threshold of 15 µg haemoglobin (Hb)/g faeces. Retrospective review of prospectively maintained data extracted from the BSP Register and New Zealand Cancer Registry identified any CRC reported in participants who returned a definitive FIT result. Further details were obtained from hospital records. FIT-ICs were primary CRC diagnosed within 24 months of a negative FIT. Factors associated with FIT-ICs were identified using logistic regression. RESULTS Of 387 215 individuals invited, 57.4% participated with 6.1% returning positive FIT results. Final analysis included 520 CRC, of which 111 (21.3%) met FIT-IC definition. Overall FIT sensitivity for CRC was 78.7% (95% CI=74.9% to 82.1%), specificity was 94.1% (95% CI=94.0% to 94.2%). In 78 (70.3%) participants with FIT-IC, faecal Hb was reported as undetectable. There were no significant associations between FIT-IC and age, sex, ethnicity and deprivation. FIT-ICs were significantly associated with proximal tumour location, late stage at diagnosis, high-grade tumour differentiation and subsequent round screens. Median follow-up time was 74 (2-124) months. FIT-IC had significantly poorer overall survival. CONCLUSION FIT sensitivity in BSP compared favourably to published data. FIT-ICs were more likely to be proximal tumours with poor long-term outcomes. Further lowering of FIT threshold would have minimal impact on FIT-IC.
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Affiliation(s)
- Kai Sheng Saw
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kerry Sexton
- National Screening Unit, New Zealand Ministry of Health, Wellington, New Zealand
| | - Paul Frankish
- Department of Gastroenterology, Te Whatu Ora - Health New Zealand Waitemata, Takapuna, New Zealand
| | - Mike Hulme-Moir
- Department of Surgery, Te Whatu Ora - Health New Zealand Waitemata, Takapuna, New Zealand
| | - Ian Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Parry
- National Screening Unit, New Zealand Ministry of Health, Wellington, New Zealand
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Al Hinai K, Fischer J, Al Mamari A, Hulme-Moir M. Improved stage and survival for patients in the Aotearoa New Zealand colorectal cancer screening program 2012-2019. ANZ J Surg 2023; 93:2669-2674. [PMID: 37287212 DOI: 10.1111/ans.18556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening was introduced in Aotearoa New Zealand at Waitematā District Health Board (WDHB) in late 2011. This study reviewed patterns of disease, treatment received, and survival of patients with national bowel screening program (NBSP)-detected CRC versus non-NBSP patients at WDHB 2012-2019. METHODS Data collected retrospectively for all patients with adenocarcinoma of the colon or rectum at WDHB 2012-2019. Patient records were manually reviewed. Chi-square, Fisher's exact test and the Mann Whitney U-test used as appropriate. Kaplan-Meier and Cox proportional hazards regression modelling for survival analysis. RESULTS 1667 patients included (360 NBSP and 1307 non-NBSP). 863 (51.8%) were male. Median age at diagnosis 73 years (range 21-100); NBSP patients were younger (median 68 vs. 76 years, P < 0.001). NBSP patients had significantly lower T, N, M and overall TNM stage than non-BSP patients. Median survival estimate on Kaplan-Meier analysis was 94 months for all patients. Statistically significant (P < 0.05) predictors of mortality on multi-variate regression analysis included increasing overall TNM stage compared with stage I (stage II HR 1.63 (95% CI 1.14-2.34), stage III HR 2.86 (95% CI 2.03-4.03), stage IV HR 7.73 (95% CI 5.59-10.68)), diagnosis within NBSP (HR 0.51 (95% CI 0.37-0.71)), increasing age in years (HR 1.03 (95% CI 1.02-1.03)), urgent/emergency surgery (HR 1.66 (95% CI 1.36-2.01)) and formal resection of primary tumour (HR 0.31 (95% CI 0.25-0.38)). CONCLUSION Patients diagnosed within the Aotearoa New Zealand NBSP were found to be younger and have earlier stage CRC. Diagnosis within the NBSP is an independent predictor of survival for patients with CRC.
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Affiliation(s)
- Khalid Al Hinai
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jesse Fischer
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland - Waikato Clinical Campus, Hamilton, New Zealand
| | | | - Mike Hulme-Moir
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
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Lekamalage BBW, Centauri SM, Arachchi A, Hulme-Moir M. Ileoanal J pouch construction. ANZ J Surg 2023; 93:687-688. [PMID: 36732916 DOI: 10.1111/ans.18301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Affiliation(s)
| | | | - Asiri Arachchi
- General Surgery, North Shore Hospital, Auckland, New Zealand
| | - Mike Hulme-Moir
- General Surgery, North Shore Hospital, Auckland, New Zealand
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Kulasegaran S, Rohan M, Pearless L, Hulme-Moir M. Pre-peritoneal local anaesthetic does not reduce post-operative pain in laparoscopic total extra-peritoneal inguinal hernia repair: double-blinded randomized controlled trial. Hernia 2017; 21:879-885. [PMID: 29038901 DOI: 10.1007/s10029-017-1672-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Laparoscopic total extra-peritoneal hernia repair (TEP) is associated with less post-operative pain and earlier return to normal activity compared to open hernia repair (OHP). Despite this, post-operative pain remains a major issue. The aim of this double-blinded randomized controlled trial was to identify whether the instillation of local anaesthetic in the pre-peritoneal space improves pain scores following TEP. METHODS One hundred patients undergoing laparoscopic total pre-peritoneal hernia repair (TEP) between the years of 2009-2014 were included. Patients were randomly assigned to receive either 20 mL of normal saline or 0.25% bupivacaine with adrenaline. Visual analogue scores (VAS 0-10) were recorded post-operatively at the 4 h, 1 day, 2 weeks, and 6 week mark. Secondary endpoints included complications, time to discharge, and return to normal activity. RESULTS 51 patients were allocated to the local group. 49 patients were allocated to the placebo group. The baseline characteristics and demographics of patients in both groups were comparable. Patients in the local group had similar VAS scores compared to the placebo group at both 4 h (1.1 vs. 1.4, respectively; p = 0.19) and 24 h (2.1 vs. 2.3; p = 0.63). No statistically significant difference noted in other primary and secondary outcomes. CONCLUSION Although the concept of pre-peritoneal local anaesthetic instillation following laparoscopic TEP is attractive, this appropriately powered study has failed to show any advantage in pain scores at 4 and 24 h. The pain scores recorded, however, were remarkably low in both groups.
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Affiliation(s)
- S Kulasegaran
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - M Rohan
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - L Pearless
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand.,Southern Cross Surgery-North Harbour, Auckland, New Zealand
| | - M Hulme-Moir
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand. .,Southern Cross Surgery-North Harbour, Auckland, New Zealand. .,Department of General Surgery, North Shore Hospital, PO Box 93503, Auckland, New Zealand.
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Woodfield J, Hulme-Moir M, Ly J. A comparison of the cost of primary closure or rectus abdominis myocutaneous flap closure of the perineum after abdominoperineal excision. Colorectal Dis 2017; 19:934-941. [PMID: 28436214 DOI: 10.1111/codi.13690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/30/2017] [Indexed: 12/13/2022]
Abstract
AIM Perineal wound complications following abdominoperineal resection continue to be a major challenge. The aim of this study was to compare the clinical outcomes and cost of primary closure (PC) and rectus abdominis myocutaneous (RAM) flap reconstruction. METHOD This was a retrospective case review of consecutive patients by one surgeon over 11 years. Patient demographics, risk factors, operative details and complications were identified. Inpatient and outpatient costs were calculated. RESULTS A total of 31 patients underwent a RAM reconstruction and 37 a PC. There were no significant differences in the incidence of wound complications or in the overall costs for either method of perineal closure. When there were no complications the mean costs were significantly higher in the RAM group ($20 948 vs $17 189, P = 0.005), mainly because of the longer operating time. However, the costs of perineal wound complications were greater in the PC group (8394 vs 25 911, P = 0.012). These wounds took longer to heal (median 2 months vs 5.5 months, P = 0.005) and more often required a further reconstructive surgical procedure (RAM 0 vs PC 8, P = 0.006). CONCLUSION This is the first study reporting on the cost implications of PC and RAM flap reconstruction. The overall costs were similar. This implies appropriate clinical selection when choosing between procedures. While the RAM flap is more expensive to perform, the finding that it decreases the clinical severity and cost of perineal wound complications supports its use when there is a high risk of perineal wound complications.
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Affiliation(s)
- J Woodfield
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - M Hulme-Moir
- Department of Surgery, North Shore Hospital, Waitakere District Health Board, Auckland, New Zealand
| | - J Ly
- Department of Surgery, North Shore Hospital, Waitakere District Health Board, Auckland, New Zealand
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Kulasegaran S, Wilson EJ, Vasquez L, Hulme-Moir M. Varicella zoster virus: a rare cause of acute pancreatitis in an immunocompetent child. BMJ Case Rep 2016; 2016:bcr-2015-213581. [PMID: 26762351 DOI: 10.1136/bcr-2015-213581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 15-year-old girl with a diagnosis of varicella zoster virus (VZV) presented to hospital with severe abdominal pain. This patient was immunocompetent and found to have acute pancreatitis in association with VZV. She responded well to intravenous acyclovir and supportive treatment. A review of the literature for the management of pancreatitis associated with VZV suggests treatment with acyclovir, as it appears to reduce hospital stay and symptoms. The exact benefit is yet to be quantified. Importantly, this diagnosis should be considered in children who have VZV associated with abdominal pain.
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Affiliation(s)
| | | | | | - Mike Hulme-Moir
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand
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Cha R, Murray MJ, Thompson J, Wall CR, Hill A, Hulme-Moir M, Merrie A, Findlay MPN. Dietary patterns and information needs of colorectal cancer patients post-surgery in Auckland. N Z Med J 2012; 125:38-46. [PMID: 22729057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To test the feasibility of collecting dietary data from colorectal cancer (CRC) patients in Auckland, New Zealand and to investigate their dietary information needs post-surgery, in terms of current information sources and satisfaction. METHODS A food frequency questionnaire was used to collect information on the dietary intake and patterns of patients who had undergone surgical resection of CRC in the Auckland region. Dietary intakes were compared to the Ministry of Health Food and Nutrition Guidelines for Adult New Zealanders (FNG-MoH) along with other publications of dietary patterns in patients with CRC. Participants were also asked to report on what dietary information they received and their satisfaction with this information. RESULTS Thirty participants completed the survey. Sixty-seven percent and 50% of participants met the recommended daily servings of fruit and vegetables respectively in the FNG-MoH. Four distinct dietary patterns were described for the study population. Over 50% of participants indicated that they did not receive any dietary information after surgery. CONCLUSION We were able to collect dietary information from this patient group, and this demonstrated that a significant proportion of the study population did not meet the FNG-MoH guidelines for recommended daily fruit and vegetable servings, and that there is an unmet information need in this patient group.
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Affiliation(s)
- Ryan Cha
- School of Medicine, The University of Auckland, Auckland, New Zealand
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Hulme-Moir M. The New Zealand bowel screening pilot. N Z Med J 2012; 125:9-12. [PMID: 22729053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Affiliation(s)
- J Marnewick
- Colo-Rectal Unit, Department of General Surgery, North Shore Hospital, Auckland, New Zealand
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Abstract
Retrorectal tumors are uncommon and are usually managed by open surgical excision. Recent advances in laparoscopic techniques have led to the use of laparoscopy for a variety of problems in colorectal surgery, including the excision of retrorectal tumours. This case report, which describes the laparoscopic excision of a benign schwannoma arising from the second sacral nerve root, highlights the benefits of accurate preoperative diagnosis with MR imaging and the advantages of a laparoscopic approach while pointing out principles that should be adhered to when using this approach. The tumour was successfully resected without neural compromise and with a prompt and full postoperative recovery.
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Affiliation(s)
- M Rao
- The John Goligher Colorectal Unit, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK
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Sammour T, Kahokehr A, Hayes J, Hulme-Moir M, Hill A. Warming and Humidification of Insufflation Co2 in Laparoscopic Colonic Surgery - A Double-Blinded Randomised Controlled Trial. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wright DM, Parry S, Arnold J, Bissett I, Hulme-Moir M, Parry B. CR07�*IMMUNOHISTOCHEMISTRY FOR LOSS OF EXPRESSION OF MISMATCH REPAIR GENE PROTEINS IN YOUNG PATIENTS WITH COLORECTAL CANCER: THE AUCKLAND EXPERIENCE. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.04915_7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ch'ng S, Hulme-Moir M. New Zealand's early experience in stapled haemorrhoidopexy. N Z Med J 2006; 119:U1880. [PMID: 16532046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
AIM Stapled haemorrhoidopexy is being increasingly integrated into the available options for treatment of haemorrhoidal disease. This study aimed to investigate the postoperative complications encountered in New Zealand up to December 2003. METHOD A postal survey was conducted of surgeons who perform stapled haemorrhoidopexy in New Zealand. RESULTS 28 of 29 surgeons responded. Reports on complications, including postoperative bleeding, urinary retention, sepsis, rectovaginal fistula, faecal incontinence, faecal urgency, anal stricture and persistent anal pain, and incidence of residual disease were encouraging and comparable with other studies. CONCLUSION Stapled haemorrhoidopexy is becoming increasingly accepted by New Zealand surgeons as data and experience continue to be reassuring on the safety and efficacy of the procedure.
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Affiliation(s)
- Sydney Ch'ng
- Colorectal Unit, North Shore Hospital, Takapuna, Auckland, New Zealand
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Abstract
Gastric volvulus is a rare condition which usually presents with intermittent abdominal pain. It is typically associated with a paraoesophageal hiatus hernia and may present with acute strangulation or perforation. The mortality associated with an acutely obstructed volvulus may be up to 50%. Correspondingly, this condition is regarded as a surgical emergency. We present the history of a patient with an acute gastric volvulus and unexplained hypotension.
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Affiliation(s)
- D A Cairns
- University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh.
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Abstract
Understanding of hemorrhoidal pathology and treatment has come a long way. The theory of a sliding anal canal lining and the knowledge that hemorrhoidal cushions are a normal part of the anal anatomy should encourage symptom control rather than radical removal of tissue. Techniques that fix the cushions back in position can be performed in outpatients with reasonable success rates. When required, surgery should be aimed at symptomatic hemorrhoids. It is hoped that new developments such as circular stapling and better pain management will promote increased day surgery, better pain control, and less time off work for patients.
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Affiliation(s)
- M Hulme-Moir
- Department of Colorectal Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
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Abstract
Single-stage surgery is an acceptable option in the modern management of many acute colonic conditions. Anastomosing unprepared colon is a major concern. A technique is described that allows on-the-table colonic lavage to be performed without contamination of the abdominal cavity.
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Affiliation(s)
- M Hulme-Moir
- University Department of Surgery, Auckland Hospital, New Zealand
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Abstract
BACKGROUND This study was undertaken to assess the outcome of Lichtenstein's tension-free mesh inguinal herniorrhaphy as practised by surgeons in a provincial centre in Taranaki, New Zealand. METHODS A prospective audit was carried out on all patients who underwent this procedure in Taranaki. They were followed up at 1 month and again at 1 year. Results were entered on a standardized pro forma. RESULTS One hundred and twenty-four patients underwent 134 repairs by four different surgeons and their registrars. Eighty-two per cent of them had a general anaesthetic, and 13% had local anaesthestic. Twenty-five per cent of the repairs were performed as day surgery and a further 53% required overnight stays. Complication rates were 6% in hospital, 12.7% at I month and 8% at 1 year. Recurrence occurred in one repair (0.9%) and there were no cases of mesh rejection. The wound infection rate was 3% and all were minor. Only 45% of the patients who had an inguinal hemiorrhaphy were employed and they took an average of 16 days (range 2-30) to return to work. Over half felt that that they could have returned to normal activities within 2 weeks. CONCLUSIONS The Lichtenstein technique of inguinal herniorrhaphy is a technically simple, reliable procedure with minimal morbidity and patients may expect a reasonably prompt return to work and to normal activities.
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Affiliation(s)
- M Hulme-Moir
- Department of General Surgery, Taranaki Base Hospital, New Plymouth, New Zealand.
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