Angus Lee

• MBBS, FRACS
• Colorectal and General Surgeon at Bendigo Health

Background: Gas exchange-derived variables obtained from cardiopulmonary exercise testing allow objective assessment of functional capacity and hence physiological reserve to withstand the stressors of major surgery. Field walk tests provide an alternate means for objective assessment of functional capacity that may be cheaper and have greater acc...

Background Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods In this secondary cross-sectional analysis of the...

Background: Rectal cuff and anal transitional zone neoplasia is an increasing challenge in patients with familial adenomatous polyposis who have undergone restorative proctocolectomy. Its real incidence, range of severity, and treatment efficacy are poorly documented. Objective: We sought to document the evolution of rectal cuff and anal transit...

The advent of artificial intelligence (AI) has significantly influenced various medical domains, including general surgery. This research aims to assess ChatGPT, an AI language model, in its ability to shed light on the historical facets of general surgery and pinpoint opportunities for innovation. A series of 7 pertinent questions on field of gene...

Purpose: A small proportion of colorectal cancer (CRC) surgical patients will require an admission to an intensive care unit (ICU) within the early postoperative period. This study aimed to compare the characteristics and outcomes of patients admitted to an ICU following CRC surgery per hospital type (metropolitan vs. rural) over a decade in Austr...

Background: Evidence-based management of acute pancreatitis (AP) is important for patient outcomes. The present study evaluated suggestions by artificial intelligence (AI) chatbot system, ChatGPT, for the management of acute pancreatitis, its alignment with clinical guidelines, and assistance in clinical decision-making. Methods: Six questions on p...

Background Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve the perioperative outcomes of emergency major abdominal surgery (EMAS). This project aims to identify whether the introduction of RPRA with the ‘National Emergency Laparotomy Audit (NELA) Calculator’ as standard‐of‐care for EMAS at a regional Vi...

Purpose: Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve outcomes following Emergency Major Abdominal Surgery (EMAS). This project aims to identify whether the introduction of RPRA as standard of care for EMAS at a regional Victorian hospital has improved postoperative outcomes, improved postoperative C...

Background and Objective: In the face of advancing technologies and a greater understanding of human physiology and psychology, preoperative care is on the cusp of a paradigm shift. Healthcare is moving towards an emphasis on holistic care and technologies such as those of artificial intelligence (AI) are being implemented rapidly. This review aime...

EAGLE is an international study bringing together surgeons, anaesthetists and theatre teams around the world to share best practice. The common goal is to reduce the global anastomotic leak rate after right colectomy and ileocaecal resection. Feel free to join ESCP Safe-anastomosis programme.

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-devel...

Objective To investigate the effect of pre‐rehabilitation interventions such as nutrition and exercise for patients with head and neck cancer (HNC). Methods Web of Science, PubMed, Scopus, Google Scholar, and Cochrane databases were searched up to December 2022. Quality of life, length of hospital stay, postoperative complications, change in body...

Background Appendicitis is a common surgical condition that requires urgent medical attention. Recent advancements in artificial intelligence and large language processing, such as ChatGPT, have demonstrated potential in supporting healthcare management and scientific research. This study aims to evaluate the accuracy and comprehensiveness of Chat...

Background: The growing interest in artificial intelligence (AI) has spurred an increase in the availability of Large Language Models (LLMs) in surgical education. These LLMs hold the potential to augment medical curricula for future healthcare professionals, facilitating engagement in remote learning experiences, and assisting in personalised stud...

Background: Patients with familial adenomatous polyposis who have undergone restorative proctocolectomy can develop adenomas in the pouch. Objective: We reviewed our experience with pouch surveillance and created a classification system for polyposis severity. Design: A retrospective review of patients undergoing ileal pouch-anal anastomosis a...

ChatGPT in surgical research and practice: a threat to academic integrity, authorship, and divergent thinking Dear Editor, In the rapidly evolving field of artificial intelligence (AI), OpenAI's large language model (LLM), ChatGPT is set to leave indelible marks on academia and healthcare. 1 Amongst its numerous AI applications, ChatGPTs utility is...

Purpose: Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obst...

Introduction and importance: Surgical resection is the mainstay for management of splenic flexure cancers, with the aim of achieving adequate lymphadenectomy. Left-sided bowel resections often require ligation of the inferior mesenteric vein (IMV) for mesocolic dissection or lymphadenectomy which can result in congestive colitis on the anal side o...

Purpose: A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of su...

Prehabilitation in conjunction with the Enhanced Recovery After Surgery (ERAS) program aims to promote earlier return to baseline function and reducing postoperative complications. This is particularly important in managing gastrointestinal cancer (GI) patients undergoing surgery. An evidence-based critique will be made in regard to the prehabilita...

This chapter aims to outline the basic principles in using anorectal manometry including indications, methods, and result interpretation. The use of defecography, an important adjunct in pelvic floor investigation, will be discussed at the end of the chapter.

Background: Inflammatory bowel disease patients are at increased risk of venous thromboembolism. Objective: To define the economic burden associated with inpatient venous thromboembolism after surgery for IBD, which presently remains undefined. Design: A retrospective, cross-sectional analysis using the National Inpatient Sample from 2004-2014...

Purpose/Background: Anal transitional zone (ATZ) dysplasia in familial adenomatous polyposis (FAP) patients who have undergone restorative proctocolectomy (IPAA) is an increasing challenge. The true incidence, range of severity, and effectiveness of treatment are poorly documented. We reviewed our experience with ATZ surveillance and management in...

Background We previously reported our pilot experience using thromboelastography (TEG) to assess hypercoagulability in 19 inflammatory bowel disease (IBD) surgical patients. We now report our expanded experience in 55 patients. Our hypothesis is that a hypercoagulable TEG (HyperTEG) profile is associated with post-operative venous thromboembolism (...

BACKGROUND Venous thromboembolism (VTE) may be considered an extra-intestinal manifestations of inflammatory bowel disease (IBD) related to inflammation associated hypercoagulability, and at least 4% of patients requiring surgery for IBD develop a VTE post-operatively. However, the economic burden associated with VTE after surgery for IBD has not b...

BACKGROUND Hypercoagulability in patients with inflammatory bowel disease (IBD) is a hematological extra-intestinal manifestation thought to be driven by the gut inflammatory response. However, mechanisms driving the coagulation abnormalities are poorly understood. The aim of this study is to characterize coagulation profiles in IBD surgical patien...

BACKGROUND In 1972, Professor Nils Kock in Gothenburg Sweden developed the continent ileostomy (Koch pouch or KP) as an alternative to permanent end ileostomy. However, the KP was largely supplanted by the ileal pouch-anal anastomosis (IPAA). In the 21st century, KP's are rarely performed, and often only in highly select patients who are a not cand...

Surgical patients with inflammatory bowel disease (IBD) bring unique risk factors for venous thromboembolism (VTE), including Virchow’s triad of inflammation-associated hypercoagulability, stasis (ex. bed-rest from fatigue between frequent trips to the bathroom, prolonged operations), and the obvious trauma of surgery [1–3]. In this population, we...

Lay Summary Crohn’s disease is an inflammatory condition of the intestine with an unknown cause and can result in inflammation, narrowing (stricuture) or penetrating disease (fistula that inflammation goes through the wall of the bowel and into another structure). Unfortunately Crohn’s disease can affect anywhere in the gastrointestinal tract, all...

Abstract Patients with inflammatory bowel disease who undergo ileal pouch-anal anastomosis are at finite risk of developing neoplasia of various parts of the pouch. In this review article, we will describe different forms of pelvic pouch-related cancers, with a focus on diagnosis and management of small bowel adenocarcinomas of the pouch body, rect...

The publisher regret that a typographical error was present in the Table 1 of the original version of this article. The value “20,032” should have been “2” in the Variable column under T stage. The correct table is now presented correctly in this article.

Background The primary aim of this study was to investigate whether a preoperative elevation in serum CEA is an independent prognostic factor for both 5-year overall and disease-free survival within an Australian patient cohort. Materials and methods A retrospective study of a prospectively maintained colorectal neoplasia database for patients bet...

Background Hypercoagulability in patients with inflammatory bowel disease (IBD) is a haematological extra-intestinal manifestation thought to be driven by the gut inflammatory response. However, mechanisms driving the coagulation abnormalities are poorly understood. The aim of this pilot study is to characterise coagulation profiles in IBD surgical...

Background The economic burden associated with VTE after surgery for IBD has not been reported. Therefore, we aimed to use a large national database to define the rate of post-operative VTE, and VTE-associated healthcare costs. Methods A retrospective, cross-sectional analysis was performed using National Inpatient Sample data from 2010 to 2014. T...

Background In 1972, Professor Nils Kock in Gothenburg Sweden developed the continent ileostomy (Koch pouch or KP) as an alternative to permanent end ileostomy. However, the KP was largely supplanted by the ileal pouch-anal anastomosis (IPAA). In the 21st century, KP’s are rarely performed, and often only in highly select patients who are a not cand...

Backgrounds A significant number of patients with colorectal cancer will have an emergency presentation requiring surgery. This study aims to evaluate short-term outcomes for patients undergoing emergency colorectal cancer surgery in Australasia. Methods All consecutive CRC from the Bi-National Colorectal Cancer Audit Database was interrogated fro...

Background Venous thromboembolism (VTE) may be considered an extra-intestinal manifestations of inflammatory bowel disease (IBD) related to inflammation associated hypercoagulability, and at least 4% of patients requiring surgery for IBD develop a VTE post-operatively. However, the economic burden associated with VTE after surgery for IBD has not...

Background: In 1972, Professor Nils Kock in Gothenburg Sweden developed the continent ileostomy (Koch pouch or KP) as an alternative to permanent end ileostomy. However, the KP was largely supplanted by the ileal pouch-anal anastomosis (IPAA). In the 21st century, KP’s are rarely performed, and often only in highly select patients who are a not can...

Background Hypercoagulability in patients with inflammatory bowel disease (IBD) is a hematological extra-intestinal manifestation thought to be driven by the gut inflammatory response. However, mechanisms driving the coagulation abnormalities are poorly understood. The aim of this pilot study is to characterize coagulation profiles in IBD surgical...

Background Lymph node yield (LNY) of 12 or more in resection of colorectal cancer is recommended in current international guidelines. Although a low LNY (less than 12) is associated with poorer outcome in some studies, its prognostic value is unclear in patients with early‐stage colorectal or rectal cancer with a complete pathological response foll...

Purpose: Although low lymph node yield (LNY <12) is associated withpoorer outcome, its prognostic value is unclear in early stage CRC and thosewith complete pathological response (pCR) after neoadjuvant therapy. Lymph node ratio (LNR) has been reported to be more accurate in predict-ing outcome in stage 3 CRC. Our aim was to identify factors linked...

Background: Pancreaticoduodenectomy is often required in patients with duodenal adenoma and adenocarcinoma and these patients generally have soft pancreatic texture and small pancreatic ducts, the two most significant factors associated with post-operative pancreatic fistula (POPF). The aims of the study were to evaluate the rate of POPF and long-...

Purpose: Prolonged traumatic CSF rhinorrhoea can lead to meningitis which carries signifi cant mortality and morbidity. We aimed to evaluate the outcome in patients with traumatic CSF rhinorrhoea.Methodology: This was a retrospective analysis of patients with traumatic ACF fracture admitted at the Alfred Hospital, Victoria, Australia from 2004 to 2...