Day 2 :
Keynote Forum
Maria Nicola
Semmelwis University, Faculty of Medicine, Budapest, Hungary
Keynote: The Importance of Sentinel Lymph Node Biopsy in Tumour Surgery
Time : 09:30-10:00
Biography:
Dr. Maria Nicola has completed her Primary Medical Qualification at Semmelweis University in Budapest, Hungary for which she graduated with honours. During her time at Semmelweis, she completed her Master of Science in Medicine as well as her MD on the Impostance of the Sentinel Lymph Node Biopsy, with a particular focus on Breast Surgery, a field she wants to subspecialise in after General Surgical Training. She is currently an FY2 trainee in the NHS and an aspiring surgeon.
Abstract:
The Sentinel Lymph Node Biopsy (SLNB) has become the standard of care for the detection of metastasis, staging and management of breast, head and neck, pelvic tumours and melanoma.This meta-analysis study proves the importance of the SLNB and the decreased morbidity with breast conserving surgery compared to Axillary Lymph Node Dissection (ALND).
From the trials included, advantages of the SLNB identified were decreased arm morbidity, decreased benefit from ALND due to earlier detection (Breast Conserving Surgery (BCS)+SLNB can be sufficient), the same Disease Free Survival (DFS) and Overall Survival (OS) between the ALND and SLNB groups, possibility of removing suspicious nodes that are not blue, cost minimising compared to ALND only group (ie. Radical/ total mastectomy). Disadvantages included False Negative Rates (FNR) of 5,1-7.3% which were affected by the number of mapping agents used and SLNs examined; False Positive Rates (FPR) of 14%; the technique is highly dependent on the surgeon’s technique; there are several contraindications to SLNB and Dye risks and lastly, the technique increases intra-operative time & cost compared to simple mastectomy or BCS alone.
The study emphasised the need to create a uniform protocol to decrease the variables in the trials; Materials used varied (Radio-colloid, blue dye or both), injection site, surgeon's experience, high/low risk patients as well as age and ethnicity. In order to decrease the FNR, the use of Dual Agent mapping is recommended and in clinically suspicious nodes or tumours larger than 3cm additional Axillary Sampling should be carried out.
Session Introduction
Da Wei Thong
Gold Coast University Hospital, Gold Coast, Australia
Title: Department of Head and Neck Surgery, Sichuan Cancer Centre
Biography:
Dr Da Wei Thong completed his medical degree (MBBS) at Monash University, Australia in 2013. Dr Thong is currently pursuing a Master (MSc) in Surgical Sciences with University of Edinburgh, UK and is in his final year of study. He is currently working as an unaccredited surgical registrar at Gold Coast Health, Australia. His main clinical interests lie in General Surgery. He is affiliated with Griffith University as a lecturer to medical students and is an active advocate of surgical research works. He had previously published and presented in conferences in Asia.
Abstract:
Aim
The primary outcome is to investigate surgeons’ compliance to antibiotics guidelines for management of appendicitis in Australia peri and postoperatively, with the secondary outcome looking at predictors of post-operative complication; surgical site infection(SSI) and intra-abdominal abscess in 30 days.
Methods
A multicentre, prospective, observational study was conducted in a period of 2 months between June and October 2016. A database with prefilled variables are completed by each local principal investigators with a protocol guidance. Patients whom underwent laparoscopy with the intention of appendicectomy were recruited in the study.
Results
A total of 1189 patients were recruited. Therapeutic guidelines antibiotic version 15 (Australian Clinical Practice Guidelines, 2014) is used to compare compliance. Guidelines endorses all patients receive antibiotics peri-operatively; 1081(92.1%) received antibiotics in this study. The rate of peri-operative antibiotic use increases with the severity of appendicitis. Highest use was in the gangrenous group, 81(98.1%) followed by complicated, 191(93.2%) and non-appendicitis, 156(85.7%). 593(51.0%) and 379(32.6%) patients received post-operative intravenous(IV) and oral antibiotics respectively. Following simple appendicectomy, only 391(56.6%) patients did not receive post-operative antibiotics as per guidelines. However, in gangrenous and complicated appendicitis, it is reassuring to see 89(98.9%) and 198(97.1%) patients received antibiotics post-operatively. Aboriginal and Torres-Strait-Islander(5.5x) and laparoscopy converted open appendicectomy(9.5x) increases the odds of SSI. This is also statistically significant post multivariable logistic analysis (p<0.05). Complicated appendicitis, operated by senior surgeon and received IV or oral antibiotics post-operatively increases the odds of intra-abdominal abscess.
Conclusion
We recommend more awareness and implementation are required for antibiotics prescription guidelines for optimal management of appendicitis in Australia.
PremKumar A
Bangalore Medical College &Research Institute,India
Title: Feasibility of Enhanced postoperative recovery pathways in emergency minimal access surgery
Biography:
PremKumar completed his Masters in surgery in 2007.He has been working as faculty at Bangalore medical college since 2008. He is currently pursuing my PhD in minmal access surgery. He has special interst in mininmal access surgery ,endocrine surgery and bariatric surgery.
Abstract:
Background:
Minimal access surgery is an imperative element of ERAS and has significantly improved the outcomes. Enhanced recovery after surgery (ERAS) programs synonym “fast track” surgery “was first conceived by Dr Henrich Kelhet. Largely described for colorectal surgery and reported to be feasible and useful for maintaining physiological function and smooth the progress of recovery. Most of the patients who present for surgical emergency are not adequately prepared and many are not in normal physiological state. The feasibility of ERAS protocol in such emergency minimal access surgery remains indistinct. This study was designed to validate an ERAS program in patients who undergo emergency minimal access surgery.
Methods:
The subjects were patients who underwent emergency minimal access surgery between June 2016 and august 2017 at the Victoria hospital, Bangalore. They received perioperative care according to an ERAS program. All data were collected and analyzed. The end point was the incidence of hospital stay, pain and postoperative complications.
Results: A total of 135 patients were studied. According to the Clavien-Dindo classification, the incidence of ≥ grade 2 postoperative complications was 10.8% and that of ≥ grade 3 complications was 3.9%. Nearly all patients did not require delay of meal step-up (95.1%). Only 6 patients (3.0%) underwent reoperation. The median postoperative hospital stay was 9 days. Only 4 patients (2.0%) required readmission. There was no mortality.
Conclusions: Our results suggest that our ERAS program is feasible in patients who undergo emergency minimal access surgery.
Frank Battaglia
University of Ottawa Faculty of Medicine, Canada
Title: Investigating Gender Disparity in Academic General Surgery in North America
Biography:
Frank Battaglia is in the midst of completing his MD from the University of Ottawa after studying Physiology at McGill University. He is a student researcher at the University of Ottawa Heart, specializing in General and Cardiac Surgery. He has published 2 papers, presented 6 research projects, is the head of his school’s Surgery Interest Group and President of his Medical Student Society at the University of Ottawa.
Abstract:
Background
Across many industries, the varying disparities between genders in who is hired or promoted have been well identified. When appraising the field of academic general surgery, it is important to see if there is an overall gender inequity in those entering the field, as well as if there is an underrepresentation of gender at ascending academic or leadership ranking. Furthermore, it is important to elucidate the factors that could be leading to this inequality.
Study Design
Data was collected from general surgical departments offering residency training in USA and Canada. The information gathered about faculty members included gender, quantification of bibliometrics, and academic achievement. Frequency and percentages were noted for the qualitative variables; median and ranges were reported for the quantitative variables. The chi-square test (χ2) was used to determine any association between gender and academic ranking, as well as gender with leadership ranking.
Results
There were a significantly higher number of men [3094 (79.39%)] among the academic faculty in the specialty of general surgery in North America, compared to women [803 (20.61%)] (χ2=55.046; p-value≤0.001). This trend was also seen in leadership roles, where there were significantly more men [463 (84.03%)] than women [88 (15.97%)] (χ2=8.35; p-value=0.004). When the h-index was adjusted by the years of research conducted by the faculty members of general surgery (m-index), we found that women outperform men in academic productivity at every level of academic appointment.
Conclusions
Women make up the minority of senior surgical faculty and leadership in the U.S. and Canada, despite the fact they are more academically productive for every year for which they are involved in research compared to men. This suggests that institutions are not considering research productivity equally to inform promotion, or whether academic productivity is considered secondary to other factors.