ac Lynch

Sydney Adventist Hospital · Department of Surgery

This article describes a post-fellowship preceptorship training program to train sub-specialty colorectal surgeons in gaining proficiency in robotic colorectal surgery using a dual-surgeon model in the Australian private sector. The Australian colorectal surgeon faces challenges in gaining robotic colorectal surgery proficiency with limited exposur...

Background Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurab...

Introduction The study examined whether increased physical activity (PA) in nonmetropolitan cancer survivors was maintained 12 weeks following the PPARCS intervention. Methods PA outcomes were assessed using an accelerometer at baseline, end of the intervention, and at 24 weeks. Linear mixed models were used to examine between‐group changes in PA...

Background: Physical activity (PA) is important for cancer survivors. Trials of remotely delivered interventions are needed to assist in reaching under-served non-metropolitan cancer survivors. The objective of this study was to ascertain whether wearable technology, coupled with health coaching was effective in increasing PA in breast and colorec...

Purpose Cancer survivors are at risk of comorbidities, with those in non-metropolitan areas being particularly susceptible. Survivors identify unique barriers and supports to facilitate change, which may differ across survivors’ geographical classification. Methods Survivors from metropolitan (n = 103) and non-metropolitan (n = 80) areas in Austra...

Background: A robotic approach to total colectomy/proctectomy and ileal pouch reconstruction would seem to be a sensible use of the platform's enhanced reach, visualization, and dexterity. Objective: Current published data for robotic ileal pouch surgery is discussed. Study selection: There are a paucity of published data to date representing...

Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the opti...

Background: Pre-clinical studies indicate that dry-cold-carbon-dioxide (DC-CO2) insufflation leads to more peritoneal damage, inflammation and hypothermia compared with humidified-warm-CO2 (HW-CO2). Peritoneum and core temperature in patients undergoing colorectal cancer (CRC) surgery were compared. Methods: Sixty-six patients were randomized in...

Recent innovations within the field of robotic surgery have particular relevance to colorectal surgery. Although a robotic approach has been associated with satisfactory outcomes, there remains a wide variation in levels of adoption. In particular, this study focuses on patient positioning, docking, and table placement, with the intent of understan...

Background PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) is a minimally invasive approach relying on physical principles for improving intraperitoneal drug delivery, including optimizing the homogeneity of drug distribution through an aerosol. Feasibility and safety of the new approach are now consolidated and data on its effectiveness a...

Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to treat patients with peritoneal cancer. A recent survey demonstrated considerable diversification of current practice of PIPAC raising issues of concern also regarding safety and efficacy. The study aim was to reach consensus on best practice of PIPAC treatme...

Background and aims The role of laparoscopic rectal cancer resection remains controversial. Thus, we aimed to conduct a one-stage meta-analysis with reconstructed patient-level data using randomized trial data to compare long-term oncologic efficacy of laparoscopic and open surgical resection for rectal cancer. Methods Medline, EMBASE and Scopus w...

Total pelvic exenteration (TPE) involves the en‐bloc removal of all the pelvic organs, namely the rectum, prostate, and bladder in male patients, and the rectum, uterus and ovaries, vagina, and bladder in female patients. Pelvic exenteration has evolved over time from a procedure that would only be considered in very selective circumstances to one...

Background and Aims: The role of laparoscopic rectal cancer resection remains controversial. Previous meta-analyses of survival outcomes have utilized a standard meta-analytical approach less amenable to the incorporation of flexible and robust survival models. Thus, we aimed to conduct a one-stage meta-analysis with reconstructed patient-level dat...

Importance The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensi...

Background A resection with clear margins (R0 resection) is the most important prognostic factor in patients with locally recurrent rectal cancer (LRRC). However, this is achieved in only 60 per cent of patients. The aim of this study is to investigate whether the addition of induction chemotherapy to neoadjuvant chemo(re)irradiation improves the R...

PurposeCancer survivors are at risk of comorbidities and mortality, and those living outside of metropolitan areas are particularly susceptible given poorer socioeconomic, health and support resources. As engagement in health behaviours is affected by participants’ autonomous motives, investigation of the motives of cancer survivors in metropolitan...

Background The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collect...

Background Insufflation with CO2 can employ continuous flow, recirculated gas and/or additional warming and humidification. The ability to compare these modes of delivery depends upon the assays employed and opportunities to minimize subject variation. The use of pigs to train colorectal surgeons provided an opportunity to compare three modes of CO...

Objective: Interventions to increase physical activity (PA) in cancer survivors have often adopted a 'one-size-fits-all' approach, and may benefit from being tailored to psychological constructs associated with behavior. The study objective was to investigate the exercise preferences and psychological constructs related to PA among cancer survivor...

Background The management of patients presenting with malignant small bowel obstruction is a challenging paradigm. The aim of this systematic review was to examine different management strategies in these complex patients. The primary outcomes evaluated were the type of intervention, 30‐day morbidity and mortality and overall survival rates. Metho...

Aim The decision to perform an abdominoperineal resection (APR) over restorative bowel resection relies on a number of clinical factors. There remains great variability in APR rates internationally. The aim of this study was to demonstrate trends of APR surgery in low rectal cancer (<6cm) in Australasia and identify predictors of non‐restoration....

Background Pelvic exenteration remains a viable and effective treatment option for the management of locally advanced or recurrent pelvic malignancy. The aim of this study was to present an early experience of robotic multivisceral resection of pelvic malignancy, and to compare this experience with similar series through a systematic review of the...

Background: Familial cases of appendiceal mucinous tumours (AMTs) are extremely rare and the underlying genetic aetiology uncertain. We identified potential predisposing germline genetic variants in a father and daughter with AMTs presenting with pseudomyxoma peritonei (PMP) and correlated these with regions of loss of heterozygosity (LOH) in the...

Introduction Robotic transanal minimally invasive surgery (R‐TAMIS) is gaining traction around the globe as an alternative to laparoscopic conventional TAMIS (L‐TAMIS) for local excision of benign and early malignant rectal lesions. Aims To analyse patient and oncological outcomes of R‐TAMIS in a single centre of consecutive cases. Methods A pros...

Peritoneal metastases confer the worst survival among all sites in patients with metastatic colorectal cancer. They develop largely through transcoelomic spread, with a sequence of events that allow cells to first detach from primary tumours, survive in the peritoneal environment, attach to the peritoneal surface of organs and migrate into the subm...

Background: A total of 15-20% of patients with rectal cancer patients have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, and often dependent on local resources and available expertise. Methods: members of the PelvEx Collaborative were invited to partic...

The liver is the most common anatomical site for hematogenous metastases from colorectal cancer. Therefore effective treatment of liver metastases is one of the most challenging elements in the management of colorectal cancer. However, there is rare available clinical consensus or guideline only focusing on colorectal liver metastases. After six ro...

Background: Pelvic exenteration has increasingly been shown to improve disease-free and overall survival for patients with locally advanced pelvic malignancies. Squamous cell carcinoma (SCC) is the second most common pelvic malignancy requiring exenteration. Objective: The aim of this study was to report the clinical and oncological outcomes fro...

Background Familial cases of appendiceal mucinous tumours (AMTs) are extremely rare and the underlying genetic aetiology uncertain. We identified potential predisposing germline genetic variants in a father and daughter with AMTs presenting with pseudomyxoma peritonei (PMP) and correlated these with regions of loss of heterozygosity (LOH) in the tu...

Background and objectives: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) offers selected patients with peritoneal surface malignancies (PSM) an improved survival. However, a substantial proportion of patients develop peritoneal recurrence. There is limited data on the efficacy of iterative CRS and HIPEC in such...

Background: The exposure of the peritoneum to desiccation during surgery generates lasting damage to the mesothelial lining which impacts inflammation and tissue repair. We have previously explored open abdominal surgery in mice subjected to passive airflow however, operating theatres employ active airflow. Therefore, we sought an engineering solu...

Background: Patients who undergo radical pelvic surgery, often have problems with perineal wound healing and pelvic collections. While there is recognition of the perineal morbidity, there also remains uncertainty around the benefit of VRAM flaps due to the balance between primary healing and the complications associated with this form of reconstr...

We would like to thank Slim et al (ref) for their comments pertaining to the recently published systematic review on surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer recently published in Colorectal Disease (1). The authors state that wherever possible data should be pooled to permit meta‐analysis but comment that this wa...

Background There is great variability in the uptake of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of colorectal peritoneal metastases (CRPM) in Australia and New Zealand. This study aims to provide a snapshot of perceptions among colorectal surgeons in the management of CRPM. Methods A stru...

Background: Colorectal cancer is the second leading cause of cancer-related mortality worldwide. Peritoneal metastases carry the worst prognosis among all sites of colorectal cancer metastases. In recent years, the advent and acceptance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have greatly improved survival for select...

Background Familial cases of appendiceal mucinous tumours (AMTs) are extremely rare and the underlying genetic aetiology uncertain. We identified potential predisposing germline genetic variants in a father and daughter with AMTs presenting with pseudomyxoma peritonei (PMP) and correlated these with regions of loss of heterozygosity (LOH) in the tu...

Introduction: Minimally invasive surgical approaches for cancer of the right colon have been well described with significant patient and equivalent oncological benefits. Robotic surgery has advanced in its ability to provide multi-quadrant abdominal access, leading the surgical community to widen its application outside of the pelvis to other abdo...

Background Peritoneal surface malignancy (PSM) was historically associated with a poor survival. The adoption of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can now offer patients with PSM a favourable overall survival. Here, we report our single-institute outcomes following CRS and HIPEC for PSM and evaluate...

Background: Despite advances in the rates of total mesorectal excision (TME) for rectal cancer surgery, decreased local recurrence rates and increased 5-year survival, there still exists large variation in the quality of treatment received. Up to 30 per cent of rectal cancers are locally advanced at presentation and approximately 5-10 per cent sti...

Objective: To examine the changes in exenterative surgery over three decades analysing oncological outcomes and whether changes in surgical approach have led to improved patient outcomes. Background: Advances in surgical technology, perioperative care and pattern of disease recurrence have coincided with an evolutionary change in exenterative su...

Objective: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). Methods: A systema...

Background Pseudomyxoma peritonei (PMP) is a rare clinical presentation, with considerable morbidity and mortality if left untreated. In recent decades, there is growing acceptance for the use of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). The aim of this study was to report on our 10-year single-center experience...

Background: There is increasing literature emerging on the significance of tumor-infiltrating lymphocytes in colorectal cancer. However, there have been inconsistent findings, secondary to small patient numbers and varied methods for identifying these lymphocytes. Objective: The aim of this study was to determine the prognostic and predictive po...

Background Appendiceal epithelial neoplasms are rare cancers. Management of peritoneal disease from appendiceal neoplasms has historically been with debulking surgery. In recent decades, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care. Here, we report our single institu...

Abdominal cocoon is a rare entity with no known aetiology and is a clinical curiosity in the surgical field, and a management dilemma for surgeons. Treatment may include excision of the accessory peritoneal sac with lysis of the inter-loop adhesions. Bowel resection is unnecessary unless a nonviable segment is found. However, if there are no signs...

Purpose The presence of tumor-infiltrating lymphocytes (TILs) in tumors is superior to conventional pathologic staging in predicting patient outcome. However, their presence does not define TIL functionality. Here we developed an assay that tests TIL cytotoxicity in patients with locally advanced rectal cancer before definitive treatment, identifyi...

PurposeRadical management of locally recurrent rectal cancer (LRRC) can lead to prolonged survival. This study aims to assess outcomes and identify prognostic factors for patients with LRRC treated using a multimodality treatment protocol. Methods An analysis of a prospectively maintained institutional database of consecutive patients who underwent...

BACKGROUND: Rectal cancer outcomes have improved with the adoption of a multidisciplinary model of care. However, there is a spectrum of quality when viewed from a national perspective, as highlighted by the Consortium for Optimizing the Treatment of Rectal Cancer data on rectal cancer care in the United States. OBJECTIVE: The aim of this study was...

Fig. S1 Evaluation of tumour formation at 10 days after abdominal delivery of CT26 cancer cells, in mice subjected to humidified‐warm carbon dioxide and controls. a (i) peritoneal tumour formation indicated by the white arrow at the wound bound by sutures and surgical clips at the surgical incision site at 10 days post‐delivery of 1000 CT26 cells i...

Background The current standard of care for locally advanced rectal cancer involves neo‐adjuvant chemo‐radiotherapy followed by total mesorectal excision. There is a spectrum of response to neo‐adjuvant therapy, however the prognostic value of tumour regression grade(TRG) in predicting disease‐free survival (DFS) or overall survival (OS) is inconsi...

BACKGROUND: Anal squamous cell carcinoma is a rare cancer with a high cure rate, making research into the treatment of locoregional failure difficult. OBJECTIVE: The purpose of this study was to examine factors related to local treatment failure and determine the outcomes of patients undergoing local salvage resection. DESIGN: This was a retrospe...

Background: The aim of this study was to monitor the effect of humidified-warm carbon dioxide (HWCO2 ) delivered into the open abdomen of mice, simulating laparotomy. Methods: Mice were anaesthetized, ventilated and subjected to an abdominal incision followed by wound retraction. In the experimental group, a diffuser device was used to deliver H...

OBJECTIVE: The aim of the study was to analyze data from an international collaboration, and ascertain prognostic indicators that inform clinical decision-making and practices regarding the role of pelvic exenteration for locally advanced primary rectal cancer (LARC). BACKGROUND: With improved national screening programs fewer patients present with...

The peritoneum is the second most common site of metastasis after the liver and the only site of metastatic disease in approximately 25% of patients with colorectal cancer (CRC). In the past, peritoneal carcinomatosis in CRC was thought to be equivalent to distant metastasis; however, the transcoelomic spread of malignant cells is an acknowledged a...

Introduction Rectal cancer outcomes have improved with the adoption of a multidisciplinary model of care. It is well-documented that circumferential resection margin (CRM) involvement remains a strong predictor of outcome and quality of care. However there is a spectrum of quality when viewed from a national perspective, as highlighted by the OSTR...

Purpose/Background: Hartmann’s reversal (Hr) is major surgery to restore colonic continuity. traditionally it is undertaken by open surgery (roH), with a morbidity and mortality of up to 50% and 15% respectively. due to the significant post-operative risk, there is a trend towards performing laparoscopic reversal of Hartmann’s procedure (lrHP). the...

Purpose/Background: Anal squamous cell carcinoma (SCC) has more than doubled in incidence over the last forty years without an improvement in survival. While chemoradiotherapy achieves a good outcome for many patients, a significant number suffer from persistent disease and local relapse. this study examines factors related to treatment failure fol...

Background Currently there are no reliable methods that can adequately predict response to neoadjuvant chemoradiotherapy (NACRT) in locally advanced rectal cancer. However tumour infiltrating lymphocytes (TILs) have gained significant traction in predicting response and the aim was to assess whether a novel cytotoxic immune assay measuring the kin...

Importance: Global health systems are shifting toward value-based care in an effort to drive better outcomes in the setting of rising health care costs. This shift requires a common definition of value, starting with the outcomes that matter most to patients. Objective: The International Consortium for Health Outcomes Measurement (ICHOM), a nonp...

Background: Intraoperative hypothermia is linked to postoperative adverse events. The use of warmed, humidified CO2 to establish pneumoperitoneum during laparoscopy has been associated with reduced incidence of intraoperative hypothermia. However, the small number and variable quality of published studies have caused uncertainty about the potentia...

Background: Surgical site infections remain a significant burden on healthcare systems and may benefit from new countermeasures. Aim: To assess the merits of open surgical wound CO2 insufflation via a gas diffuser to reduce airborne contamination, and to determine the distribution of CO2 in and over a wound. Methods: An experimental approach w...

Background: Positron emission tomography/computed tomography (PET/CT) is an important modality in cancer imaging. With its increasing availability and use, it is not uncommon to detect incidental focal colorectal (18) F-FDG uptake which poses a diagnostic challenge, as they may be associated with malignant or pre-malignant colorectal lesions. The...

Purpose/Objectives: To ascertain individual experiences of extended bowel resection as treatment for colorectal cancer (CRC) in those with a high metachronous CRC risk, including the self-reported adequacy of information received at different time points of treatment and recovery. Research Approach: Qualitative. Setting: Participants were recruit...

Rectal cancer can recur locally in up to 10% of the patients who undergo definitive resection for their primary cancer. Surgical salvage is considered appropriate in the curative setting as well as select cases with palliative intent. Disease-free survival following salvage resection is dependent upon achieving an R0 resection margin. A clear under...

Aim: To provide an update on the aetiology, pathogenesis, diagnosis, staging and management of rectal squamous cell carcinoma (SCC). Methods: A systematic review was conducted according to the preferred reporting items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE was performed with the reference lis...

Background: Management of rectal cancer has become multidisciplinary and is driven by the stage of the disease, with increased focus on restaging rectal cancer after neoadjuvant therapy. Objective: The purpose of this study was to assess the relative impact of restaging after preoperative chemoradiation with FDG-PET scan, CT, and MRI in the mana...