Congratulations to Bankstown Hospital staff on their recently published articles
Mercieca-Bebber R, Eggins R, Brown K, Gebski VJ, Brewer K, Lai L, Bailey L, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Wilson K, Hague W, Hayes J, White S, Morgan Matt, Simes RJ, Stevenson ARL. Patient-Reported Bowel, Urinary, and Sexual Outcomes After Laparoscopic-Assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial (ALaCart). Ann Surg. 2023 Mar 1;277(3):449-455. doi: 10.1097/SLA.0000000000005412. Epub 2022 Feb 15. PMID: 35166265.
Objective: The aim of this study was to compare patient-reported urinary, bowel, and sexual functioning of ALaCaRT Trial participants randomized to open or laparoscopic surgery for rectal cancer.
Summary background data: The primary endpoint, noninferiority of laparoscopic surgical resection adequacy, was not established.
Methods: Participants completed QLQ-CR29 at baseline, 3, and 12 months post-surgery. Additionally, women completed Rosen's Female Sexual Functioning Index (FSFI). Men completed the International Index of Erectile Function (IIEF) and QLQ-PR25. We compared the proportions of participants in each group who experienced moderate/severe symptoms/dysfunction at each time-point and compared mean difference scores from baseline to 12 months between groups. All analyses were intention-to-treat. Sexual functioning analyses included only the participants who expressed sexual interest at baseline.
Results: Baseline PRO compliance of 475 randomized participants was 88%. At 12 months, a lower proportion of open surgery participants experienced moderate-severe fecal incontinence and sore skin, compared to Laparoscopic participants, and a lower proportion of men randomized to open surgery experienced moderate-severe urinary symptoms. There were no differences at 3 months for bowel or urinary symptoms. Sexual functioning among sexually interested participants was similar between groups at 3 and 12 months; however, a lower proportion of women reported moderate to severe sexual dissatisfaction at 3 months in the open as compared to the laparoscopic group, (Rebecca.mercieca@sydney.edu.au., 95% CI 0.03-0.39).
Discussion: Despite the slightly lower proportions of open surgery participants self-reporting moderate-severe symptoms for 3 of 16 urinary/bowel domains, and lack of differences in sexual domains, it remains difficult to recommend one surgical approach over another for rectal resection.
Dreyer, S. B., Upstill-Goddard, R., Legrini, A., Biankin, A. V., Jamieson, N. B., Chang, D. K., Jamieson, N. B., Asghari, Ray, Merrett, Neil. D., Das, Amitabha, ... Chang, D. K. (2022). Genomic and Molecular Analyses Identify Molecular Subtypes of Pancreatic Cancer Recurrence. Gastroenterology, 162(1), 320-324.e324. https://doi.org/10.1053/j.gastro.2021.09.022
Integrated genomic analysis of 456 pancreatic ductal adenocarcinomas identified 32 recurrently mutated genes that aggregate into 10 pathways: KRAS, TGF-β, WNT, NOTCH, ROBO/SLIT signalling, G1/S transition, SWI-SNF, chromatin modification, DNA repair and RNA processing. Expression analysis defined 4 subtypes: (1) squamous; (2) pancreatic progenitor; (3) immunogenic; and (4) aberrantly differentiated endocrine exocrine (ADEX) that correlate with histopathological characteristics. Squamous tumours are enriched for TP53 and KDM6A mutations, upregulation of the TP63∆N transcriptional network, hypermethylation of pancreatic endodermal cell-fate determining genes and have a poor prognosis. Pancreatic progenitor tumours preferentially express genes involved in early pancreatic development (FOXA2/3, PDX1 and MNX1). ADEX tumours displayed upregulation of genes that regulate networks involved in KRAS activation, exocrine (NR5A2 and RBPJL), and endocrine differentiation (NEUROD1 and NKX2-2). Immunogenic tumours contained upregulated immune networks including pathways involved in acquired immune suppression. These data infer differences in the molecular evolution of pancreatic cancer subtypes and identify opportunities for therapeutic development.
Chan, D. K. Y., et al. (2022). "Strong Predictive Algorithm of Pathogenesis-Based Biomarkers Improves Parkinson's Disease Diagnosis." Molecular Neurobiology 59(3): 1476-1485: MEDLINE: 34993845
Diab, J., et al. (2022). "A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome." ANZ Journal of Surgery 92(7-8): 1742-1747: MEDLINE: 35104014
Foong, L. H. (2022). "Anti-racism in the emergency department: Navigating clinician experiences of racism." Emergency Medicine Australasia 34(1): 116-119: MEDLINE: 34965613.
Hall, S. A. L., et al. (2022). "Stopping nucleot(s)ide analogues in non-cirrhotic HBeAg-negative chronic hepatitis B patients: HBsAg loss at 96 weeks is associated with low baseline HBsAg levels." Alimentary Pharmacology & Therapeutics 56(2): 310-320: MEDLINE: 35521992.
Hong, T., et al. (2022). "Hepato-pancreato-biliary fellowship training in Australia and New Zealand: reflections and perspectives." ANZ Journal of Surgery 92(6): 1302-1303: MEDLINE: 35688635.
Kim, Y. H., et al. (2022). "Computational investigation of particle penetration and deposition pattern in a realistic respiratory tract model from different types of dry powder inhalers." International Journal of Pharmaceutics 612: 121293: MEDLINE: 34808267.
Rajkomar, K. and C. R. Berney (2022). "Large hiatus hernia: time for a paradigm shift?" BMC Surgery 22(1): 264: MEDLINE: 35804332.