ANZ Journal of Surgery | 2021
Abstract Journal General Surgery
Abstract
Journal General Surgery GS001 SENTINEL LYMPH NODE BIOPSY FOR HIGH RISK THIN (T1B) MELANOMA: THE QUEENSLAND EXPERIENCE OVER 16 YEARS HARRISON THEILE, JULIE MOORE, NATHAN DUNN, PIP YOUL AND MARK SMITHERS Queensland Cancer Control Analysis Team, QLD Purpose: Current Australian guidelines recommend sentinel lymph node biopsy (SLNB) be considered for patients with melanoma >0.75 mm Breslow thickness with other “high risk pathological features.” Our aim was to assess Queensland SLNB practice for high risk thin (T1b) melanoma. Methods: Retrospective data was extracted from the Queensland Oncology Repository on all Queensland patients diagnosed with AJCC eighth Edition T1b cutaneous primary melanoma from 2002 to 2017 inclusive. Patient demographic, geographic and melanoma clinico-pathologic characteristics, SLNB status and nodal recurrence were analysed. Results: Over 16 years in Queensland, 6979 T1b melanomas were diagnosed, of which 232 (3.3%) underwent SLNB. SLNB was more likely (p < 0.05) to be performed for T1b patients who were female, younger age, higher Breslow thickness, ulcerated and nodular subtype. Fewer patients had SLNB for lesions located on the head and neck. 20 patients had a positive SLNB (8.6%). Regional nodal recurrence in T1b patients who did not undergo SLNB was more likely (p < 0.05) in younger patients, and those with greater Breslow thickness. SLNB was clustered at major city hospitals, with patients from regional/rural areas (2.3%) undergoing SLNB less often than those from major cities (4.0%). Conclusions: SLNB was positive in 8.6% of AJCC eighth Edition T1b melanoma cases, which supports SLNB being performed for these high risk thin melanoma patients. Despite this, only 3.3% of T1b patients underwent SLNB. Further education, training and resource allocation to expand access to SLNB for T1b melanoma would be beneficial for patient care given the volume of melanoma disease, especially in rural/remote areas considering the geographical breadth of Queensland. GS002 OUTCOMES OF PATIENTS WITH METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA TO THE AXILLA: A MULTICENTRE COHORT STUDY PHILLIP YANG, MICHAEL VENESS, EDWARD COOPER, RICHARD FOX, ROBERT SMEE, CHRISTOPHER LEHANE, PHILIP CROWE, JULIE HOWLE AND STEPHEN THOMPSON Prince of Wales Hospital, NSW Aim: Metastatic cutaneous squamous cell carcinoma (cSCC) to the axilla is uncommon, with limited data to guide management. We sought to assess the outcomes of patients with this condition after surgery and radiotherapy. Methods: A retrospective cohort study of patients treated at two Australian hospitals from 1994 through 2016 was performed. Disease-free survival (DFS), overall survival (OS), and cumulative incidence of regional recurrence were calculated and their predictors were determined. Results: Seventy-four patients were identified, including 48 treated curatively with surgery-plus-radiotherapy and 15 with surgery alone, making this the largest modern series of its type. Compared with patients treated with surgery alone, a higher proportion of patients treated with surgeryplus-radiotherapy had lymph nodes larger than 6 cm (53% vs. 8%, p = 0.012) and multiple adverse histopathological features (75% vs. 47%, p = 0.04). The groups had similar 5-year DFS (45% vs. 46%) and OS (51% vs. 48%). Presence of multiple positive lymph nodes was associated with reduced DFS (hazard ratio = 4.57, p = 0.01) and OS (hazard ratio = 3.53, p = 0.02). Regional recurrence was higher in patients treated with surgery alone (38% vs. 22%, p = 0.22) and patients with lymph nodes larger than 6 cm (34% vs. 10%, p = 0.03). All recurrences occurred within 2 years following treatment. Conclusion: Combined-modality therapy for metastatic cSCC to the axilla is recommended for high risk patients, though outcomes remain modest. The key period for recurrence is within 2 years following treatment. GS003 ELECTIVE SURGICAL MANAGEMENT OF PILONIDAL SINUS DISEASE IN THE NORTH METROPOLITAN HEALTH REGION OF WESTERN AUSTRALIA MARY MEI KHUAN TEOH, RAOUL OEHMEN, MUNYARADZI NYANDORO, ANDREW THOMPSON AND DAVID FLETCHER Fiona Stanley Hospital, WA Purpose: Pilonidal sinus disease (PNS) of the sacrococcygeal region is seen predominantly in young adult males with an incidence rate of 26-per100 000 populations. This study aimed to evaluate surgical techniques and associated recurrences. Methodology: A multi-centre retrospective cohort study of elective surgical PNS patients between January 2010 and December 2018 in two Perth hospitals was performed. Retrospective data was extracted including key demographics, operative techniques, co-morbidities and histopathology reports. Results: Of 183 cases analysed, 85% were male with a median age of 27. All patients underwent a complete wide local excision of their PNS. 93% had a primary off-midline flap closure, which were – Modified-KarydakisFlap (35%), Karydakis-Flap (30%), Limberg-Flap (9%), Modified-LimbergFlap (7%), Other-Flaps-Combined (12%), and Open-Techniques accounting for 7%. Karydakis-Flap had highest recurrence rates. Univariate regression analysis with the likelihood of PNS recurrence as the dependent variable showed patients who underwent revision surgery after having a recurrence (p = 0.01), or had wound dehiscence (p = 0.01), diabetic (p < 0.01), hirsute (p < 0.01), had a post-op surgical-site-infection (p < 0.01), or histologically involved surgical margins (p < 0.01), had higher rates of recurrence. Conclusion: This non-randomized study showed that Limberg-Flaps had the lowest rate of recurrence while Open-Techniques had the highest, therefore the utmost human and economic factor cost. Future multi-centre randomized control trials should address the question of technique superiority while minimizing associated complications and capturing patient perspectives. GS004 ENDOSCOPIC PILONIDAL SINUS TREATMENT (EPSIT): A SINGLE-CENTRE AUSTRALIAN EXPERIENCE MATHEW HINKSMAN AND KENNETH LOON Queen Elizabeth II Jubilee Hospital, QLD The purpose of this paper is to present the results of a single-centre, nonrandomized, retrospective study of Endoscopic Pilonidal Sinus Treatment (EPSiT). EPSiT is a novel minimally invasive technique for treating pilonidal sinus disease (PSD) involving endoscopic assessment & treatment. This is the first Australian study of EPSiT. From January 2014 to November 2020, 137 patients with PSD underwent EPSiT. 25 had undergone previous definitive surgery for PSD. Specialized Karl Storz video equipment (fistuloscope) was used in the procedure. The rigid fistuloscope was used to directly visualize the sinus cavity and secondary tracts. Cavities and tracts were then curetted endoscopically to remove all granulation tissues and hair/follicles. Ablation was then carried out under direct vision along with removal of necrotic material. Patients were then followed up via outpatient clinic. 72% (n = 91) of patients undergoing EPSiT achieved primary healing (needing nil further intervention) at a median of 6 weeks. 14% (n = 17) experienced healing followed by recurrence while 14% (n = 18) experienced non-healing. Of the recurrence/non-healing groups, 20/35 underwent repeat EPSiT with healing occurring in 18/20 patients at a mean of 10 weeks. The balance of patients (n = 15) underwent other definitive procedures. The mean operating time was 34 minutes. There were no major complications and 85% of patients were discharged the same day. 11 patients were lost to