Surgical Outcomes Research Centre (SOuRCe) Surgical Outcomes Research Centre (SOuRCe) SOuRCe
Home / Our research

Our research

Improving outcomes for clinical surgery patients

Our research addresses the full spectrum of evidence-based surgical practice including

  • Surgical clinical trials
  • Cost-effectiveness studies of new surgical interventions
  • Systematic reviews of the literature and meta-analysis
  • Studies of the actual uptake of research evidence and clinical practice guidelines into surgical practice
  • Measurement of patient preferences for alternate treatment options
  • Long-term studies of patient outcomes following surgical procedures.

SOuRCe undertakes a broad range of clinical and health service research that aims to improve outcomes for surgical patients. All projects follow a multidisciplinary approach bringing together expertise in clinical science, epidemiology, health economics and health psychology. Projects frequently include students and trainee clinicians to provide research training opportunities.

 

 

Our Overall Research Output

Currently, SOuRCe is involved in 173 research studies in collaboration with multi-specialty surgical departments, allied health, nursing, other academics and consumers, based in Australia and Internationally. Over 55% of our research studies are registry-nested and originate from comprehensive data collected from the funded surgical programs, including the Advanced Gastrointestinal Research Program, Robotics Program, Orthopaedic Surgery and Vascular Surgery Programs. The other 45% of our research originates from historical collaborations within the following departments: colorectal, transplant, urology, ear, nose and throat, orthopaedics, upper gastrointestinal, breast, vascular, allied health, head and neck, anaesthetics, nursing, benign gynaecology, pathology, imaging, pharmacy and other departments and institutions.

Over the past 20 years, SOuRCe has rapidly developed to become one of the major Australian surgical research units, and is now a centre of surgical research excellence with international recognition. During this time, SOuRCe was awarded over $20M in competitive funding, including major funding bodies such as the NHMRC, MRFF, CINSW, NIHR and others. SOuRCe has published over 500 peer-reviewed scientific articles in the top surgical and medical journals, including NATURE, BMJ, JAMA surgery, Annals of Surgery, The British Journal of Surgery, Journal of Surgical Oncology and others high impact journals. SOuRCe has supervised over 70 PhD and MPHIL students and over 60 MD students. These achievements have contributed significantly to the enhancement of patient outcomes and have changed clinical practice at RPAH, Australia and Internationally.

 

 

Funded Research Programs

Our funded surgical research programs include the Advanced Gastrointestinal Surgical Program (including Pelvic Exenteration, Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy, Retroperitoneal Sarcoma and Advanced Upper Gastrointestinal Surgery), Robotics Program, Orthopaedic Surgery, Vascular Surgery, and the Preoperative Optimisation Research Program. Most of the funded research programs are governed by the RPA Institute of Academic Surgery and are led by a large amount of multidisciplinary and multispecialty groups of clinical and non-clinical staff from a variety of departments across RPAH.

 

 

 

 

 

 

 

 





 


 

                

            


        
    
        
            

                

                    
Pelvic Exenteration Surgery


Summary of Program


Pelvic exenteration is a highly complex surgical procedure performed in selected patients presenting with locally advanced or recurrent pelvic malignancies. From 1994 to June 2022, 996 pelvic exenteration procedures have been performed at RPAH, which is the largest cohort of patients treated by a single institution worldwide. This has led to international recognition of RPAH being highly regarded for its novel multidisciplinary approach, expertise, innovation in surgical techniques, outstanding patient outcomes, and high quality scientific output.


The Pelvic Exenteration research program has developed two main databases that collect surgical outcomes (PESQI) and patient-reported outcomes (QOLPE) of all patients undergoing surgery at RPAH. Patients are followed from baseline (time before surgery) to 5 years postoperative with several measures, including quality of life outcomes. The program continues to evolve with 37 studies currently being conducted incorporating topics of surgical techniques, surgical outcomes, survival, decision-making, quality of life, nutrition, depression, anxiety, stress, physical activity, 3D printing and cost. In addition, the Pelvic Exenteration team was successful in receiving a competitive grant from the National Health and Medical Research Council. The team also published 19 peer-reviewed research manuscripts in national and international journals during this reporting period.


Surgical Patient Flow




* The pelvic exenteration multidisciplinary team meetings commenced in 2009. † Including 42 redo surgeries.


 


Surgical Volume




Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • From 1994 to June 2022, 996 pelvic exenteration surgeries were performed at RPAH, involving 916 unique patients. The 1000th pelvic exenteration is expected to be performed in July 2022. This is an amazing milestone for the program and will be the first single centre in the world to perform such an amount of pelvic exenterations. Data from these patients are entered into our surgical registry, which includes detailed patient characteristics and surgical outcomes.
    • 

  • Of the 996 pelvic exenteration surgeries performed at RPAH, 651 of these patients consented to participate in the long-running study titled ‘Quality of Life in patients following pelvic exenteration surgery’, since the beginning of this prospective cohort study in 2008. This study was initially funded by Cancer Australia and the Cancer Council Australia through the Priority-driven Collaborative Cancer Research Scheme. Currently, quality of life and other patient-reported outcomes are collected at 9 distinct time points from baseline (before surgery) to 5 years postoperatively.
    • 

  • The RPAH Pelvic Exenteration program is a member of the PelvEx Collaborative. PelvEx is an international collaborative group involving >140 units across the world with the aim to explore outcomes following pelvic exenteration. Recently, SOuRCe has completed an international benchmarking. This benchmark analysis has demonstrated that patients undergoing pelvic exenteration surgery at RPAH underwent more complex procedures including wider resections of bony pelvis, resulting in increased surgical times and postoperative recovery, but most importantly, achieved higher rates of clear resection margins (R0), lower 30-day mortality and superior survival outcomes. These results are a credit to the large group of multi-disciplinary staff involved in the delivery of the RPAH Pelvic Exenteration Surgical Program.
    • 



International Benchmarking of Surgical Outcomes Following Pelvic Exenteration




Recent Publications


    

  • Solomon M, Däster S, Loizides S, Sutton P, Brown K, Austin K, Lee P. Access to the anterior pelvic compartment in pelvic exenteration in women-the interlabial approach: Video vignette. The British Journal of Surgery, 2021. 108(8), p268-269. DOI: 10.1093/bjs/znab127.
    • 

  • Däster S, Shin J, Loizides S, Steffens D, Koh C, Solomon M. Pathology reporting of pelvic exenteration specimens for locally recurrent rectal cancer. European Journal of Surgery Oncology, 2021. 47(8), p2100-2107. DOI: 10.1016/j.ejso.2021.03.258.
    • 

  • Alahmadi R, Steffens D, Solomon M, Lee P, Austin K, Koh C. Elderly patients have better quality of life but worse survival following pelvic exenteration: A 25-year single-center experience. Annals of Surgical Oncology, 2021. 28(9), p5226-5235. DOI: 10.1245/s10434-021-09685-6.
    • 

  • Alahmadi R, Solomon M, Steffens D. ASO author reflections: Quality of life and survival outcomes in elderly patients undergoing pelvic exenteration. Annals of Surgical Oncology, 2021. 9, p5236-5237. DOI: 10.1245/s10434-021-09759-5.
    • 

  • Makker P, Koh C, Solomon M, Ratcliffe J, Steffens D. Functional outcomes following pelvic exenteration: Results from a prospective cohort study. Colorectal Disease, 2021. 23(10), p2647-2658. DOI: 10.1111/codi.15834.
    • 

  • Solomon M, Sutton P, Lee P, Austin K. Perineal urethrectomy in the anterior compartment for pelvic exenteration. The British Journal of Surgery, 2021. 108(11), e364. DOI: 10.1093/bjs/znab286.
    • 

  • Yu X, Goldsbury D, Feletto E, Koh C, Canfell K, O’Connell D. Socioeconomic disparities in colorectal cancer survival: Contributions of prognostic factors in a large Australian cohort. Journal of Cancer Research and Clinical Oncology, 2021. 25, p1–14. DOI: 10.1007/s00432-021-03856-4.
    • 

  • Vuong K, Alchin L, Solomon M, Koh C, Steffens D. A prospective investigation of pain and fatigue following pelvic exenteration. European Journal of Surgery Oncology, 2021. 47(12), p3137-3143. DOI: 10.1016/j.ejso.2021.07.022.
    • 

  • Huang Y, Steffens D, Solomon M, Koh C. Differences in surgical outcomes and quality of life outcomes in pelvic exenteration between locally advanced versus locally recurrent rectal cancer. Diseases of the Colon & Rectum, 2022. 24(S1). p101. DOI: 10.1111/codi.16050
    • 

  • Koh C, Brown K, Steffens D, Young J, Salkeld G, Solomon M. What constitutes a clear margin in patients with locally recurrent rectal cancer undergoing pelvic exenteration?. Annals of Surgery, 2022. 275(1), p157-165. DOI: 10.1097/SLA.0000000000003834.
    • 

  • Chang K, Solomon M. The role of surgery in the palliation of advanced pelvic malignancy. European Journal of Surgery Oncology, 2022. S0748-7983(22), e00045-2. DOI: 10.1016/j.ejso.2022.01.019.
    • 

  • Hogan S, Reece L, Solomon M, Rangan A, Carey S. Early enteral feeding is beneficial for patients after pelvic exenteration surgery: A randomized controlled trial. Journal of Parenteral and Enteral Nutrition, 2022. 46(2), p411-421. DOI: 10.1002/jpen.2120.
    • 

  • Hogan S, Steffens D, Vuong K, Rangan A, Solomon M, Carey S. Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients: A retrospective study. Nutrition and Health, 2022. 28(1), p41-48. DOI: 10.1177/02601060211009067.
    • 

  • Steffens D, Young J, Riedel B, Morton R, Denehy L, Heriot A, Koh C, Li Q, Bauman A, Sandroussi C, Ismail H, Dieng M, Ansari N, Pillinger N, O’Shannassy S, McKeown S, Cunningham D, Sheehan K, Iori G, Bartyn J, Solomon M. PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: Protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL). BMC Cancer, 2022. 22(1), e443. DOI: 10.1186/s12885-022-09492-6.
    • 

  • Lee P, Meshkat B, Sasidharan P, Zahid A, Coker D, Solomon M. Survival and morbidity outcomes after pelvic exenteration for pelvic sarcoma: an institutional series. ANZ Journal of Surgery, 2022. 92(5), p1038-1043. DOI: 10.1111/ans.17275.
    • 

  • Solomon M, Alahmadi R, Lee P, Austin K. En bloc partial pubic bone excision with complete soft tissue pelvic exenteration. The British Journal of Surgery, 2022. 109(7), p640-641. DOI: 10.1093/bjs/znac122.
    • 

  • Lim C, Laidsaar-Powell R, Young J, Solomon M, Steffens D, Yeo D, Blinman P, Koczwara B, Joshy G, Advanced-CRC Survivorship Authorship Group, Butow P. The long haul: Lived experiences of survivors following different treatments for advanced colorectal cancer: A qualitative study. European Journal of Oncology Nursing, 2022. 58, e102123. DOI: 10.1016/j.ejon.2022.102123.
    • 

  • Huang Y, Wang X, Steffens D, Young J, Solomon M, Koh C. Grading complications in pelvic exenteration: Limitations of current classification systems. Diseases of the Colon & Rectum, 2022. Online ahead of print. DOI: 10.1097/DCR.0000000000002396.
    • 

  • Sutton P, Brown K, Ebrahimi N, Solomon M, Austin K, Lee P. Long term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome. Colorectal Disease, 2022. Online ahead of print. DOI: 10.1111/codi.16238.
    • 



Recent Presentations


    

  • Solomon M. Decisional conflict and bias in the interpretation of trial evidence in minimally invasive colorectal cancer surgery. Asian Pacific Digestive Week, Virtual, 19-22 August 2021.
    • 

  • Solomon MJ. Decisional conflict: Bias, equipoise and the interpretation of trial results in colorectal cancer surgery. Henry Windsor Lecture 2021, Royal Australian College of Surgeons Australian Capital Territory Annual Scientific Meeting 2021, Virtual, 27 August 2021.
    • 

  • Lim C, Laidsaar-Powell R, Young J, Solomon M, Steffens D, Koh C, Ansari N, Yeo D, Blinman P, Koczwara B, Phyllis Butow P. Psychosocial outcomes and QoL in advanced colorectal cancer survivors: A qualitative exploration. Sydney Cancer Conference, Sydney, Australia, 9-10 September 2021.
    • 

  • Lim C, Young J, Solomon M, Steffens D, Koh C, Ansari N, Yeo D, Blinman P, Butow P, Laidsaar-Powell R. Quality of life and survivorship experiences of advanced colorectal cancer: A large qualitative study. International Psycho-Oncology Society (IPOS) World Congress, Toronto, Canada, 29 August – 1 September 2021.
    • 

  • Koh C. Unforgettable cases. Invited presentation. The Sydney University Surgical Society, Sydney, Australia, 13 October 2021.
    • 

  • McCarthy A, Coker D, Steffens D, Solomon M, Lee P. Abdominopelvic sarcoma: A 10-year quaternary centre experience. Australia and New Zealand Sarcoma Association Annual Scientific Meeting 2021, Virtual Webinar, 5-6 November 2021.
    • 

  • Koh C. Decision making with the patient for difficult pelvic surgeries. Invited presentation. Bulkley-Barry-Cooper Lecture, Guy’s and St Thomas’ Hospital, London, United Kingdom, 25 November 2021.
    • 

  • McCarthy A, Coker D, Steffens D, Solomon M, Lee P. Abdominopelvic sarcoma: A 10-year quaternary centre experience. Tripartite Colorectal Meeting, Auckland, New Zealand, 22-24 February 2022.
    • 

  • Solomon M. Ruthven Blackburn Medal Lecture, The University of Sydney, Sydney, Australia, 6 June 2022.
    • 



 


Peritonectomy Research Program


Summary of Program


Peritonectomy is a complex abdominal operation involving a combination of macroscopic tumour removal (cytoreductive surgery; CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) administered directly into the abdomen during surgery to kill any residual microscopic cancer cells following cytoreduction. This treatment approach has been shown to significantly increase survival, improve quality of life, and potentially offer a cure to patients with peritoneal metastases of colorectal or appendiceal origin, as well as metastatic gastric and ovarian cancer.


Due to increasing demand for this type of service, in October 2016 the NSW Government established a second state-wide Peritonectomy service at RPAH. This program has a foundation in patient monitoring and research, which includes interstate and international collaborations with other Peritonectomy centres. To ensure the continued pursuit of high quality, evidence-based practice, the patient data is centralised within a clinical and patient-reported outcomes (quality of life, work and health care utilisation) research database (PREMIER). This supports not only clinical auditing and reporting of data to the SLHD and NSW Ministry of Health (MoH), but also the ongoing development of research activity.


Surgical Patient Flow




* Including 15 redo surgeries


 


Surgical Volume




Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • The Peritonectomy Research Program at RPAH has collected information from all patients undergoing surgery to date, totalling 343 patients. This includes 294 patients that consented to provide patient-reported outcome measures from baseline (before surgery) to 5 years postoperative.
    • 

  • In April 2022, the Peritonectomy Program completed 5 years. During this period, the program was able to secure several research grants to support the ongoing success of the program. These included competitive external funding from the National Health and Medical Research Council and the Medical Research Future Fund.
    • 

  • Currently, there are over 30 research studies being conducted in a wide range of areas including surgical techniques, surgical outcomes, survival, quality of life, nutrition, depression, anxiety, stress, pain, physical activity and health economics. These studies include:

      

    • AUS-UK QoL: An international cohort study investigating quality of life outcomes following CRS & HIPEC in colorectal cancer patients. This prospective study is the first international collaboration and involves the Royal Prince Alfred Hospital and Basingstoke Hospital from the UK. The study is currently recruiting participants in both sites.
      • 

    • ReLaPSeD Trial: A large multicentre randomised controlled trial investigating overall survival in patients managed with routine second look laparoscopy versus standard follow-up following curative resection for high-risk colorectal cancer. This trial started in May 2019 and is currently recruiting participants.
      • 

    • HyNOVA Trial: A multicentre randomised study comparing hyperthermic and normothermic intraperitoneal chemotherapy following interval cytoreductive surgery for stage III epithelial ovarian, fallopian tube and primary peritoneal cancer. This trial received external funds from the Medical Research Future Fund and is currently recruiting participants.
      • 

    

    • 



Recent Publications


    

  • Steffens, D. Preoperative exercise for patients undergoing major abdominal cancer surgery. Physiotherapy Inmotion, 2021. https://australian.physio/inmotion.
    • 

  • Steffens D, Ismail H, Denehy L, Beckenkamp PR, Solomon M, Koh C, Bartyn J, Pillinger N. preoperative cardiopulmonary exercise test associated with postoperative outcomes in patients undergoing cancer surgery: A systematic review and meta-analyses. Annals of Surgical Oncology, 2021. 28(12), p7120-7146. DOI: 10.1245/s10434-021-10251-3.
    • 

  • Pillinger N, Koh C, Ansari N, Munoz P, McNamara S, Steffens D. Preoperative cardiopulmonary exercise testing improves risk assessment of morbidity and length of stay following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia and Intensive Care, 2021. 0(0), p1-10. DOI: 10.1177/0310057X211064904.
    • 

  • Garrett C, Steffens D, Ansari N, Koh C. A phase I, nonrandomized controlled trial demonstrating the novel technique of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy utilizing warm humidified carbon dioxide insufflation. Colorectal Disease, 2021. 23(6), p1573-1578. DOI: 10.1111/codi.15588.
    • 

  • McBride K, Steffens D, Solomon M, Koh C, Ansari N, Young C, Moran B. Cost-analysis of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal malignancy: An Australian perspective with global application. European Journal of Surgical Oncology, 2021. 47(4), p828-833. DOI: 10.1016/j.ejso.2020.09.010.
    • 

  • Steffens D, Young J, Riedel B, Morton R, Denehy L, Heriot A, Koh C, Li Q, Bauman A, Sandroussi C, Ismail H, Dieng M, Ansari N, Pillinger N, O’Shannassy S, McKeown S, Cunningham D, Sheehan K, Iori G, Bartyn J, Solomon M. PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: Protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL). BMC Cancer, 2022. 22(1), e443. DOI: 10.1186/s12885-022-09492-6.
    • 

  • Farrell R, Burling M, Lee Y, Pather S, Robledo K, Mercieca-Bebber R, Stockler M; HyNOVA Protocol Steering Committee. Clinical trial protocol for HyNOVA: Hyperthermic and normothermic intraperitoneal chemotherapy following interval cytoreductive surgery for stage III epithelial OVArian, fallopian tube and primary peritoneal cancer. Journal of Gynecological Oncology, 2022. 33(1), e1. DOI: 10.3802/jgo.2022.33.e1.
    • 

  • Lim C, Laidsaar-Powell R, Young J, Solomon M, Steffens D, Yeo D, Blinman P, Koczwara B, Joshy G, Advanced-CRC Survivorship Authorship Group, Butow P. The long haul: Lived experiences of survivors following different treatments for advanced colorectal cancer: A qualitative study. European Journal of Oncology Nursing, 2022. 58, e102123. DOI: 10.1016/j.ejon.2022.102123.
    • 

  • Garrett C, Steffens D, Solomon M, Koh C. Early-onset colorectal cancer: Why it should be high on our list of differentials. ANZ Journal of Surgery, 2022. Online ahead of print. DOI: 10.1111/ans.17698.
    • 



Recent Presentations


    

  • Lau B, Koh C. Preoperative assessment of peritoneal carcinomatosis: A comparative analysis of laparoscopy and CT. Sydney Cancer Conference, Sydney, Australia, 9-10 September 2021.
    • 

  • Lau H, Steffens D, Koh C. Peritoneal cancer index (PCI) calculation in the assessment of peritoneal carcinomatosis: An analysis of diagnostic concordance between laparoscopy and laparotomy. Australasian Gastro-Intestinal Cancer Trials Group Annual Scientific Meeting, Melbourne, Australia, 12-15 October 2021.
    • 

  • Makker P, Koh C, Solomon M, Ratcliffe J, Steffens D. Functional outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A prospective cohort study. Royal Australasian College of Surgeons Annual Scientific Congress, Virtual Webinar, 2-6 May 2022.
    • 



 


Upper Gastrointestinal Surgery


Summary of Program


The Upper Gastrointestinal Research Program focuses on major resection for upper gastrointestinal associated cancer within RPAH, including liver, pancreas, gastric and oesophageal. A comprehensive database was established (HUGO) to facilitate greater insight for researchers and clinicians into these very complex procedures. The collection of data allows for collaboration with other institutions, as well as easy access for clinicians within RPAH to monitor outcomes and perform quality improvement activities. The program also provides a format for a multidisciplinary team to discuss complex cases.


Surgical Patient Flow




Surgical Volume




Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • The Upper Gastrointestinal Research Program has recorded >1000 major cancer surgeries performed at RPAH since August 2017. The information from all these procedures are entered prospectively into the HUGO database, which include patient characteristics and extensive surgical outcomes. A number of research studies are nested within the HUGO Most recently the program started recruitment for the UNIQUE study (Upper Gastrointestinal Quality of life). This prospective cohort study aims to investigate quality of life outcomes following surgery for liver, biliary tract, pancreas, stomach and oesophageal disease. This long-term study will follow patients up to 5 years postoperatively.
    • 

  • The Very SuPPLe Trial is a randomised controlled trial that is investigating the effectiveness of preoperative very low calorie/energy diet two weeks prior to surgery on liver stiffness and size. This project received support from two external grants and is currently recruiting patients.
    • 

  • An artificial intelligence diagnosis study is underway, which looks to use deep learning to develop models that aid in diagnosis, and ultimately surgical decisions around hepatobiliary and pancreatic tumours. This study will be conducted in collaboration with the computational neuroimaging group at the Brain and Mind Centre, The University of Sydney.
    • 

  • The Fit-4-Home Trial was a randomised controlled trial that investigated the use of electronic devices in encouraging patients to move after surgery, reducing their hospital stay. This was a collaboration between RPAH and Chris O’Brien Lifehouse (COBLH). The results of the trial are now published in the ANZ Journal of Surgery.
    • 



Recent Publications


    

  • Toms C, Steffens D, Yeo D, Pulitano C, Sandroussi C. Quality of life instruments and trajectories after pancreatic cancer resection: A systematic review. Pancreas, 2021. 50(8), p1137-1153. DOI: 10.1097/MPA.0000000000001896.
    • 

  • Parsonson A, Connolly E, Lee M, Hruby G, Sandroussi C, Merrett N, Samra J, Mittal A, Tse R, Grimison P. Real world outcomes of neoadjuvant chemotherapy and radiotherapy for borderline resectable pancreatic cancer: A multicentre observational study. ANZ Journal of Surgery, 2021. 91(11), p2447-2452. DOI: 10.1111/ans.17151.
    • 

  • Ip E, McNeil C, Grimison P, Scheinberg T, Tudini E, Ho G, Scott R, Brown C, Sandroussi C, Guitera P, Spurdle AB, Goodwin A. Catastrophic chemotherapy toxicity leading to diagnosis of Fanconi anaemia due to FANCD1/BRCA2 during adulthood: Description of an emerging phenotype. Journal of Medical Genetics, 2021. Online ahead of print. DOI: 10.1136/jmedgenet-2021-108072.
    • 

  • Park J, Ben-David M, McKenzie C, Sandroussi C. Cytomegalovirus adrenalitis mimicking adrenal metastasis in an immunocompetent patient. Journal of Surgical Case Reports, 2022. 26(3), Online only. DOI: 10.1093/jscr/rjac122.
    • 

  • Steffens D, Solomon M, Beckenkamp P, Koh C, Yeo D, Sandroussi C; Fit-4-Home Collaborators, Hancock MJ. Individualised, targeted step count intervention following gastrointestinal cancer surgery: The Fit-4-Home randomised clinical trial. ANZ Journal of Surgery, 2022. 92(4), p703-711. DOI: 10.1111/ans.17212.
    • 

  • Xu J, D’Souza K, Lau N, Leslie S, Lee T, Yao J, Lam S, Sandroussi C, Chadban S, Ying T, Pleass H, Laurence J. Staged versus concurrent native nephrectomy and renal transplantation in patients with autosomal dominant polycystic kidney disease: A systematic review. Transplantation Reviews (Orlando), 2022. 36(1), e100652. DOI: 10.1016/j.trre.2021.100652.
    • 

  • Steffens D, Young J, Riedel B, Morton R, Denehy L, Heriot A, Koh C, Li Q, Bauman A, Sandroussi C, Ismail H, Dieng M, Ansari N, Pillinger N, O’Shannassy S, McKeown S, Cunningham D, Sheehan K, Iori G, Bartyn J, Solomon M. PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: Protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL). BMC Cancer, 2022. 22(1), e443. DOI: 10.1186/s12885-022-09492-6.
    • 

  • Bhadbhade M, Connolly E, Badiani S, Yeo D, Bhadri V. Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis. BMJ Case Reports, 2022. 15(4), e247774. DOI: 10.1136/bcr-2021-247774.
    • 

  • Wei T, Zhang X, He J, Popescu I, Marques H, Aldrighetti L, Maithel S, Pulitano C, Bauer T, Shen F, Poultsides G, Soubrane O, Martel G, Koerkamp B, Itaru E, Lv Y, Pawlik T. Prognostic impact of perineural invasion in intrahepatic cholangiocarcinoma: Multicentre study. The British Journal of Surgery. 2022. 109(7), p610-616. DOI: 10.1093/bjs/znac098.
    • 

  • Lim C, Laidsaar-Powell R, Young J, Solomon M, Steffens D, Yeo D, Blinman P, Koczwara B, Joshy G, Advanced-CRC Survivorship Authorship Group, Butow P. The long haul: Lived experiences of survivors following different treatments for advanced colorectal cancer: A qualitative study. European Journal of Oncology Nursing, 2022. 58, e102123. DOI: 10.1016/j.ejon.2022.102123.
    • 

  • Tsilimigras D, Ejaz A, Cloyd J, Guglielmi A, Aldrighetti L, Weiss M, Bauer T, Alexandrescu S, Poultsides G, Maithel S, Marques H, Martel G, Pulitano C, Shen F, Soubrane O, Koerkamp B, Endo I, Pawlik T. Tumor necrosis impacts prognosis of patients undergoing resection for T1 intrahepatic cholangiocarcinoma. Annals of Surgical Oncology, 2022. Online ahead of print. DOI: 10.1245/s10434-022-11462-y.
    • 

  • Aitchison L, Chen A, Toms C, Sandroussi C, Yeo D, Steffens D. To stitch or not to stitch: The skin closure of laparoscopic port sites, a meta-analysis. Surgical Endoscopy, 2022. Online ahead of print. DOI: 10.1007/s00464-022-09269-9.
    • 



Recent Presentations


    

  • Khoma O. State of evidence in robotic UGI surgery: What’s the benefit? Sydney Robotics and Innovation Conference 2022, Sydney, Australia, 17-18 June 2022.
    • 



 


Retroperitoneal Sarcoma Surgery


Summary of Program


Retroperitoneal sarcomas (RPS) comprise 15% of all soft tissue sarcomas (cancers arising in the connective tissue). They are malignant and can grow considerably large within the abdomen and pelvis. These may present late with obstructive symptoms and pain dependent on the organ or structure it abuts or invades. Management of patients with RPS is especially challenging when malignant and involves any vital organs or structures. The therapeutic strategies include surgical resection/removal, radiotherapy or chemotherapy, or a combination of the three. The dilemma is choosing an appropriate treatment or combination of treatments, and in which order the optimal treatment should be delivered to elicit the best response. A significant prognostic factor influencing survival is local recurrence. Hence, this and other factors such as tumour grade, size and staging need to be taken into account when deciding the optimal advent treatment for patients with RPS. In November 2020, the Retroperitoneal Sarcoma Research Program was established across RPAH and COBLH, with the overarching aim of establishing and maintaining an ongoing and comprehensive clinical and outcomes database (SPARC), nested into multiple research projects.


Surgical Patient Flow




* November 2020 – June 2022; † 1st treatment for sarcoma and then had a 2nd surgical treatment for non-sarcoma.


Surgical Volume




Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • In October 2020, RPAH has commenced collaborating research with international institutions such as Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). The main aim of this collaboration is to evaluate current outcomes and evidence in the management of patients with primary, locally recurrent, and metastatic retroperitoneal sarcoma. Currently, RPAH and COBLH are involved in the RESAR study, which includes prospective collection of primary retroperitoneal sarcoma patient’s data, radiological and pathological material.
    • 

  • From November 2020, the Retroperitoneal Research Program started the development of the Sarcoma of the Pelvis, Abdomen or Retroperitoneum Collaboration (SPARC) database for RPAH and COBLH. After receiving ethics approval in February 2021, prospective data collection commenced for all patients diagnosed with retroperitoneal sarcoma, and discussed at RPAH and COBLH multidisciplinary team meeting. The SPARC database now includes data for 144 patients. The data collected in the SPARC database includes extensive patient information, pathology, medical oncology, surgical and patient-reported outcomes, including quality of life.
    • 

  • In mid-2021, a collaboration was established between RPAH, COBLH, the ProCan facility at Children’s Medical Research Institute, Westmead Hospital and The University of Sydney, to conduct the study titled ‘Proteomics in retroperitoneal intra-abdomino-pelvic extremity soft tissue sarcomas’. This study aims to identify a proteomic signature of relapse in patients with localised leiomyosarcoma at diagnosis. Recruitment is currently underway.
    • 



Recent Publications


    

  • Lee P, Meshkat B, Sasidharan P, Zahid A, Coker D, Solomon M. Survival and morbidity outcomes after pelvic exenteration for pelvic sarcoma: An institutional series. ANZ Journal of Surgery, 2021; 92(5), p1038-1043. DOI: 10.1111/ans.17275.
    • 

  • Fewtrell M, Symons P, Hong A, Luk P, Jiang R. PAX 8 positive synovial sarcoma. Human Pathology: Case Reports, 2021. 24. DOI: 10.1016/j.ehpc.2021.200502.
    • 

  • Der Sarkissian S, Wong X, Kossard S, Hong A, Sebaratnam D. Kaposiform haemangioendothelioma in an adult: Lack of response to topical sirolimus and response to radiotherapy. Clinical Experimental Dermatology, 2022. 47(1), p192-193. DOI: 10.1111/ced.14928.
    • 

  • Connolly E, Bhadri V, Wake J, Ingley K, Lewin J, Bae S, Wong D, Long A, Pryor D, Thompson S, Strach M, Grimison P, Mahar A, Bonar F, Maclean F, Hong A. Systemic treatments and outcomes in CIC-rearranged Sarcoma: A national multi-centre clinicopathological series and literature review. Cancer Medicine, 2022. 11(8), p1805-1816. DOI: 10.1002/cam4.4580.
    • 

  • Zhou D, Bhadri V, Luk P, Ch’ng S, Franks D, Hong A. Left cheek sclerosing rhabdomyosarcoma and development of isolated free flap donor site metastasis. BMJ Case Reports, 2022. 15(4), e248390. DOI: 10.1136/bcr-2021-248390.
    • 

  • Strach M, Grimison P, Hong A, Boyle R, Stalley P, Karim R, Connolly E, Bae S, Desai J, Crowe P, Singhal N, Bhadri VA. Mesenchymal chondrosarcoma: An Australian multi-centre cohort study. Cancer Medicine, 2022. Online ahead of print. DOI: 10.1002/cam4.4849.
    • 

  • Bae S, Brnabic A, Crowe P, Carey-Smith R, Andelkovic V, Singhal N, Stalley P, Yip D, Desai J. Managing patients with advanced soft tissue sarcoma: Evolving landscape from an Australian perspective. Asia-Pacific Journal of Clinical Oncology, 2022. Online ahead of print. DOI: 10.1111/ajco.13706.
    • 



Recent Presentations


    

  • McCarthy A, Coker D, Steffens D, Solomon M, Lee P. Abdominopelvic sarcoma: A 10-year quaternary centre experience. Australia and New Zealand Sarcoma Association Annual Scientific Meeting 2021, Virtual Webinar, 5-6 November 2021.
    • 

  • McCarthy A, Coker D, Steffens D, Solomon M, Lee P. Abdominopelvic sarcoma: A 10-year quaternary centre experience. Tripartite Colorectal Meeting, Auckland, New Zealand, 22-24 February 2022.
    • 



 


Preoperative Optimisation


Summary of Program


Preoperative optimisation is the process of enhancing general health before surgery. This concept encompasses many components of care including medical, physical exercise, nutritional support and psychological support. There are multiple projects being undertaken within this research program at SOuRCe, including the areas of mental health, nutrition and exercise.


Recently, two PhD programs were completed:


 Dr Kate McBride – Surgical outcomes for patients with serious mental illness.


Mental health can greatly affect the recovery period following surgery, and those who suffer from a serious mental illness would likely be at a higher risk of a poorer outcome. This thesis found that those suffering from a serious mental illness experienced a range of considerable physical, social and occupational challenges, that affected their outcomes following surgery. These patients had greater surgical morbidity including higher postoperative complications, longer lengths of hospital stay, greater hospital readmissions, and higher costs. The evidence generated within this thesis demonstrated there is a considerable need to improve the delivery of surgical care to this vulnerable patient group.


Dr Sophie Hogan – Expanding the evidence base for perioperative nutrition management in pelvic exenteration surgery.


Patients undergoing a pelvic exenteration surgery will often have significant compromise to their colorectal system, requiring a closely monitored nutritional regime after the procedure. This thesis sought to investigate if nutrition assessment tools and/or methodologies predict outcomes after this surgery, determine beneficial perioperative nutrition support therapies. It was found that patients who were malnourished before surgery had significantly increased length of postoperative stay, surgical procedure times, intensive care unit readmissions, and decreased quality of life. Through this thesis, evidence on more effective preoperative nutrition assessments was generated.


SOuRCe was able to obtain a large NHMRC grant to develop the PRIORITY Trial. The PRIORITY Trial is a multi-centre randomised controlled trial investigating the effectiveness of a preoperative exercise and education program on patients undergoing surgery for advanced primary or recurrent gastrointestinal cancers compared to usual care. The clinical trial is being conducted at RPAH and COBLH in Sydney and Peter MacCallum Cancer Centre (PMCC), in Melbourne. The PRIORITY Trial commenced patient recruitment in November 2021.


Surgical Patient Flow 


All patients scheduled for Pelvic Exenteration, Cytoreductive Surgery (CRS), and Upper Gastrointestinal surgery (including Oesophagectomy, Hepatectomy, Gastrectomy, or Pancreatectomy) are eligible to participate.




Surgical Volume


The target recruitment for the PRIORITY Trial is 172 participants. Participant recruitment is expected to be completed by June 2024. Due to COVID-19 restrictions a contingency plan was established in October 2021, prior to the first participant being recruited. These changes were made to allow patients to participate in the trial via telehealth. To date, a total of 38 participants have been recruited into the trial (28 participants from RPAH/COBLH and 10 participants from PMCC).




Patient Characteristics




Geographic Distribution of Patients




Graph contains data on 28 participants who had surgery at RPAH.


Highlights


    

  • The PRIORITY Trial received ethical approval with the Human Research Ethics Committee at Concord Repatriation General Hospital in March 2020 and governance authorisation in May 2021. A research officer, Ms Jenna Bartyn, was appointed in December 2020 to assist in the coordination of the trial. The trial was prospectively registered within the Australian New Zealand Clinical Trial Registry (ANZCTR) in May 2021 (ACTRN12621000617864), with a detailed protocol published in BMC Cancer in April 2022. The first participant was recruited in November 2021.
    • 



During the last 3 years, a number of studies have also been established:


    

  • Preoperative technology-driven multimodal intervention for patients undergoing cancer surgery (app study): The study is looking at the barriers, facilitators and adoption of a preoperative program by surveying cancer patients undergoing surgery, their carers and treating clinicians. The study received ethical and governance approval and commenced recruitment in 2021. A total of 12 cancer patients and 7 clinicians have been recruited to date.
    • 

  • Research priorities in prehabilitation for patients undergoing cancer surgery (international Delphi study): The investigators are conducting a Delphi study with international multidisciplinary experts to identify key research priorities in prehabilitation for patients undergoing cancer surgery. Almost 200 international prehabilitation experts have currently completed the first round survey.
    • 

  • Mechanistic understanding of how preoperative exercise improves outcomes: A substudy of the NHMRC-funded PRIORITY randomised controlled trial (biomarker study): This project received funding from the Australian and New Zealand College of Anaesthetists Foundation. The study received ethics approval in November 2021 and governance approval in March 2022. All patients recruited into PRIORITY are invited to participate in this study. Currently 12 participants have been recruited.
    • 

  • Safety, feasibility and validity of remote physical assessments during the covid-19 pandemic (validation/reliability study): The study is being conducted at RPAH and Neuroscience Research Australia (NeuRA) and is investigating the validity and reliability of conducting online physical assessments in patients presenting with cancer and older people. The study received ethics and governance approval in June 2022 and will commence participant recruitment in July 2022.
    • 

  • Comparative efficacy of preoperative interventions to improve postoperative outcomes in cancer patients (network meta-analysis): This network meta-analysis is being conducted at RPAH and is looking at the comparative effectiveness of preoperative interventions in cancer patients on postoperative complications and length of hospital stay. The study is currently in the data analysis phase.
    • 

  • The role of physical, nutritional and/or psychological statuses on surgical outcomes, patients outcomes and survival following major cancer surgery: This retrospective cohort study is looking at patients who had undergone cytoreductive surgery or pelvic exenteration surgery for locally advanced or recurrent pelvic cancers. The paper is currently under review at Annals of Surgical Oncology. 
    • 

  • Reference values for the Six Minute Walking test in cancer patients: This international multicentre study, involves individual patient data form RPAH, PMCC and from another 24 sites in Canada, New Zealand and the UK. The main aim of this study is to provide reference values of the Six Minute Walking Test for cancer patients undergoing gastrointestinal surgery.
    • 



Recent Publications


    

  • McBride K, Steffens D, Lambert T, Glozier N, Roberts R, Solomon M. Acceptability and face validity of two mental health screening tools for use in the routine surgical setting. BMC Psychology, 2021. 9(171), p1-9. DOI: 10.1186/s40359-021-00672-w.
    • 

  • Makker P, Koh C, Solomon M, Ratcliffe J, Steffens D. Functional outcomes following pelvic exenteration: Results from a prospective cohort study. Colorectal Disease, 2021. 23(10), p2647-2658. DOI: 10.1111/codi.15834.
    • 

  • Steffens D, Ismail H, Denehy L, Beckenkamp PR, Solomon M, Koh C, Bartyn J, Pillinger N. preoperative cardiopulmonary exercise test associated with postoperative outcomes in patients undergoing cancer surgery: A systematic review and meta-analyses. Annals of Surgical Oncology, 2021. 28(12), p7120-7146. DOI: 10.1245/s10434-021-10251-3.
    • 

  • Pillinger N, Koh C, Ansari N, Munoz P, McNamara S, Steffens D. Preoperative cardiopulmonary exercise testing improves risk assessment of morbidity and length of stay following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia and Intensive Care, 2021. 0(0), p1-10. DOI: 10.1177/0310057X211064904.
    • 

  • Hogan S, Steffens D, Vuong K, Rangan A, Solomon M, Carey S. Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients: A retrospective study. Nutrition and Health, 2022. 28(1), p41-48. DOI: 10.1177/02601060211009067.
    • 

  • Steffens D, Solomon M, Beckenkamp P, Koh C, Yeo D, Sandroussi C; Fit-4-Home Collaborators, Hancock MJ. Individualised, targeted step count intervention following gastrointestinal cancer surgery: The Fit-4-Home randomised clinical trial. ANZ Journal of Surgery, 2022. 92(4), p703-711. DOI: 10.1111/ans.17212.
    • 

  • Steffens D, Young J, Riedel B, Morton R, Denehy L, Heriot A, Koh C, Li Q, Bauman A, Sandroussi C, Ismail H, Dieng M, Ansari N, Pillinger N, O’Shannassy S, McKeown S, Cunningham D, Sheehan K, Iori G, Bartyn J, Solomon M. PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: Protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL). BMC Cancer, 2022. 22(1), e443. DOI: 10.1186/s12885-022-09492-6.
    • 

  • Makker P, Koh C, Solomon M, Steffens D. Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: A systematic review and meta-analysis. ANZ Journal of Surgery, 2022. Online ahead of print. DOI: 10.1111/ans.17577.
    • 



Recent Presentations


    

  • Steffens D, Young J, Solomon S, Riedel B, Morton R, Denehy L, Heriot A, Koh C, Li Q, Bauman A, Sandroussi C, Ismail H, Dieng M, Ansari N, Pillinger N, O’Shannassy S, McKeown S, Cunningham D, Sheehan K, Iori G, Bartyn J. Preoperative exercise and education for patients undergoing major abdominal cancer surgery: Protocol. Sydney Cancer Conference, Sydney, Australia, 9-10 September 2021.
    • 



 


Vascular Surgery


Summary of Program


The Vascular Surgery Research Program at RPAH include research projects across open and endovascular procedures for the treatment of aneurysms, aortic dissection, peripheral arterial disease, cerebrovascular disease, superficial/deep venous disease, renal dialysis access, renal replacement therapy, leg ulcers, diabetic foot infection and vascular trauma. The Vascular Research Program has 14 currently active projects.


Surgical Patient Flow




Surgical Volume


 


Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • The Vascular Surgery Research Program collects information of all vascular surgery undertaken at RPAH into the Vascular Surgery (VaS) database. From January 2020, 878 patients were entered into the database. The main aim of this database is to provide data for internal monitoring, improvement activities and assist the development of vascular surgery research projects.
    • 

  • Currently, The Vascular Surgery Research Program has 14 active research projects at RPAH. Some of these studies include:

      

    • Vascular endothelial growth factor levels in type 2 endoleak requiring intervention: This study aims to investigate vascular endothelial growth factor and Interleukin-6 levels in patients with previous endovascular abdominal aortic aneurysms repair who have a type 2 endoleak that requires treatment due to ongoing sac enlargement, in order to assess whether the excluded abdominal aortic aneurysms sac is a source of vascular endothelial growth factor and Interleukin-6 that may potentially explain the behaviour of type 2 endoleak. This study is finalising patient recruitment at the end of 2022.
      • 

    • Changing management and outcomes of ruptured abdominal aortic aneurysm (rAAA): A comparison of endovascular vs open technique: This retrospective study aims to investigate the change in proportion of endovascular rAAA repair between 2010 and 2020 at RPAH and compare this to NSW and Australian/New Zealand data. This study data is currently being analysed.
      • 

    • Abdominal aortic aneurysm (AAA) explants in Australia: This study aims to describe the epidemiology, clinical outcomes, and changing management trends of explantation after AAA repair in Australia and correlate potential risk factors with patient outcomes. The manuscript for this study is currently being drafted.
      • 

    

    • 



Recent Publications


    

  • Tan R, Ryder I, Yang N, Lam Y, Santos M, Michael P, Robinson D, Ng M, Wise S. Macrophage polarization as a novel therapeutic target for endovascular intervention in peripheral artery disease. JACC: Basic to Translational Science, 2021. 6(8), p693-704. DOI: 10.1016/j.jacbts.2021.04.008.
    • 

  • Georgevsky D, Li Y, Pather S, Tejada-Berges T, Robinson D, Laurence J, Campbell N, Wyburn K, Liyanagama K, Narayan R, Lutz T, Chan A, Heaney S, Kitzing Y, Anderson L, Testa G, Johannesson L, Marren A. Uterus transplantation and pregnancy induction: Approved protocol at the Royal Prince Alfred Hospital. The Australia and New Zealand Journal of Obstetrics and Gynaecology, 2021. 61(4), p621-624. DOI: 10.1111/ajo.13364.
    • 

  • Rajendran S, Brown K, Solomon M, Austin K, Lee P, Robinson D, Steffens D. Complete resection of the iliac vascular system during pelvic exenteration: An evolving surgical approach to lateral compartment excision. The British Journal of Surgery, 2021. 108(8), p885-887. DOI: 10.1093/bjs/znab070.
    • 

  • Vasudevan T, Robinson D, Hill A, Ouriel K, Holden A, Gagnon J, Machan L, Nammuni I, Thomas S, Varcoe R. Safety and feasibility report on nonimplantable endovenous valve formation for the treatment of deep vein reflux. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021. 9(5), p1200-1208. DOI: 10.1016/j.jvsv.2020.12.073.
    • 

  • McLachlan R, Islam S, Sasidharan P, Loa J. Open thrombectomy for acute abdominal aortic occlusion due to tumor embolism after lung resection. Annals of Vascular Surgery, 2021. 76, 601.e13-601.e16. DOI: 10.1016/j.avsg.2021.04.049.
    • 

  • Cai T, Fisher G, Loa J. Changing patterns in Australian and New Zealand: Vascular surgery during COVID-19. ANZ Journal of Surgery, 2021. 91(11), p2389-2396. DOI: 10.1111/ans.17200.
    • 

  • de Boer M, Shiraev T, Loa J. Successful management of a large internal carotid artery aneurysm via open resection. The American Journal of Case Reports, 2021. 22, e935009. DOI: 10.12659/AJCR.935009.
    • 

  • Delaney C, Milner R, Loa J, Global Registry for Endovascular Aortic Treatment (GREAT) Investigators. The impact of degenerative connective tissue disorders on outcomes following endovascular aortic intervention in the global registry for endovascular aortic treatment. Annals of Vascular Surgery, 2022. 79, p81-90. DOI: 10.1016/j.avsg.2021.07.013.
    • 

  • Shiraev T, de Boer M, Qasabian R. Fistula puncture for left subclavian origin occlusion during zone 1 thoracic endograft. ANZ Journal of Surgery, 2022. 92(3), p580-582. DOI: 10.1111/ans.17329.
    • 

  • de Boer M, Shiraev T, Waller J, Qasabian R. Has EVAR changed the outcomes of ruptured abdominal aortic aneurysms? A decade’s worth of experience in an Australian teaching hospital. ANZ Journal of Surgery, 2022. 92(4), p730-735. DOI: 10.1111/ans.17554.
    • 

  • de Boer M, Shiraev T, Loa J. Use of suture-mediated closure devices for closure of punctures in prosthetic patches or grafts is associated with high rates of technical success and low complication rates. Vascular Endovascular Surgery, 2022. 56(3), p263-268. DOI: 10.1177/15385744211068626.
    • 

  • Ramkumar R, Shiraev T, Loa J, Qasabian R. A case of clostridium septicum aortitis. ANZ Journal of Surgery, 2022. 92(6), p1539-1541. DOI: 10.1111/ans.17319.
    • 

  • de Boer M, Joseph S, Shiraev T, Boyle R, Dubenec S. Hybrid repair of a persistent sciatic artery aneurysm. Vascular Endovascular Surgery, 2022. Online ahead of print. DOI: 10.1177/15385744221110948.
    • 

  • de Boer M, Qasabian R, Dubenec S, Shiraev T. The failing endograft: A systematic review of aortic graft explants and associated outcomes. Vascular, 2022. Online ahead of print. DOI: 10.1177/17085381221082370.
    • 

  • Shiraev T, de Boer M, Qasabian R. Indications for and outcomes of major lower limb amputations at a tertiary-referral centre in Australia. Vascular, 2022. Online ahead of print. DOI: 10.1177/17085381221080811.
    • 

  • de Boer M, Shiraev T, Waller J, Aitken S, Qasabian R. Patient and geographical disparities in functional outcomes after major lower limb amputation in Australia. Annals of Vascular Surgery, 2022. Online ahead of print. DOI: 10.1016/j.avsg.2022.02.009.
    • 

  • Shiraev T, de Boer M, Joseph S, Loa J, Qasabian R. Aortic graft explants: A single institution analysis of incidence and outcomes. Vascular, 2022. Online ahead of print. DOI: 10.1177/17085381211068219.
    • 



Recent Presentations


    

  • de Boer M, Shiraev T, Loa J. The safety of ProGlide use in PTFE vascular bypass graft puncture. Singapore Congress of Radiology and Workshops in Interventional Radiology Education Singapore 2021, Virtual Webinar, 13-15 August 2021.
    • 

  • de Boer M, Shiraev T, Loa J. The pre-close ProGlide technique in antegrade common femoral artery punctures. Singapore Congress of Radiology and Workshops in Interventional Radiology Education Singapore 2021, Virtual Webinar, 13-15 August 2021.
    • 

  • de Boer M, Shiraev T, Qasabian R. Fistula puncture for left subclavian artery origin occlusion during zone 1 thoracic endograft. Singapore Congress of Radiology and Workshops in Interventional Radiology Education Singapore 2021, Virtual Webinar, 13-15 August 2021.
    • 

  • Shiraev T, de Boer M, Qasabian R. Aortic graft explants in Australia. The Australian and New Zealand Society for Vascular Surgery 2021 Annual Scientific Conference, Virtual Webinar, 8-11 October 2021.
    • 

  • de Boer M, Shiraev T, Dubenec S. Emerging evidence for axillo-subclavian stenting post-surgical decompression. The Australian and New Zealand Society for Vascular Surgery 2021 Annual Scientific Conference, Virtual Webinar, 8-11 October 2021.
    • 

  • de Boer M, Shiraev T, Dubenec S. an external iliac artery pseudoaneurysm due to thermal injury from bone cement. The Australian and New Zealand Society for Vascular Surgery 2021 Annual Scientific Conference, Virtual Webinar, 8-11 October 2021.
    • 

  • de Boer M, Shiraev T, Loa J. Rotarex atherectomy & thrombectomy: Initial Australian experience. The Australian and New Zealand Society for Vascular Surgery 2021 Annual Scientific Conference, Virtual Webinar, 8-11 October 2021.
    • 



 


Robotic Surgery


Summary of Program


The surgical robotics program at RPAH is one of the most comprehensive multi-specialty public programs in Australia. It is truly unique in that it is governed by a comprehensive research framework whereby every patient undergoing robotic-assisted surgery (RAS) is enrolled in a research study. The use of RAS on the campus is also strongly embedded in ongoing education and training.


Currently there are five surgical specialties utilising the Intuitive Devices da Vinci Xi Surgical System at RPAH including benign gynaecology, cardiothoracic, colorectal, upper gastrointestinal and urology. In addition, the Stryker MAKO Robotic System is being used by orthopaedics in the Institute of Rheumatology and Orthopaedics (IRO) at RPAH. Clinical and patient-reported data on all robotic cases performed within the district is centralised in an overarching research database (BEST).


Surgical Patient Flow




Surgical Volume




Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • In May 2021, the 500th da Vinci Xi robotic surgery was performed at RPAH. Having performed the first robotic-assisted surgery in August 2016, this milestone reflected the multidisciplinary contributions to the SLHD Surgical Robotics Program.
    • 

  • The Department of Orthopaedic Surgery commenced recruitment for the RASKAL Trial in 2022. RASKAL is a national registry-nested, multicentre randomised trial assessing clinical, intraoperative, functional, radiographic and survivorship outcomes. This is the first trial of its kind seeking to produce a high quality comparison between robotic assisted and computer navigated surgical approaches.
    • 

  • In June 2022, the Department of Orthopaedic Surgery performed their 400th robotic surgery using the Stryker MAKO at the Institute of Rheumatology (RPAH).
    • 

  • In April 2022, the Urology team received ethical approval for their third Randomised Controlled Trial within the SLHD Surgical Robotics Program. This is a testament to the continual efforts of the Department of Urology. This newest trial aims to compare method of urinary diversion during robotic-assisted radical cystectomy, and has been supported by a recently awarded clinical research grant from the Intuitive Foundation.
    • 



Recent Publications


    

  • Elliott J, Shatrov J, Fritsch B, Parker D. Robotic-assisted knee arthroplasty: An evolution in progress: A concise review of the available systems and the data supporting them. Archives of Orthopaedic and Trauma Surgery, 2021. 141(12), p2099-2117. DOI: 10.1007/s00402-021-04134-1.
    • 

  • Shatrov J, Murphy GT, Duong J, Fritsch B. Robotic-assisted total knee arthroplasty with the OMNIBot platform: A review of the principles of use and outcomes. Archives of Orthopaedic and Trauma Surgery, 2021. 141(12), p2087-2096. DOI: 10.1007/s00402-021-04173-8.
    • 

  • Makary J, Van Diepen D, Arianayagam R, McClintock G, Fallot J, Leslie S, Thanigasalam R. The evolution of image guidance in robotic-assisted laparoscopic prostatectomy (RALP): A glimpse into the future. Journal of Robotic Surgery, 2021. Online ahead of print. DOI: 10.1007/s11701-021-01305-5.
    • 

  • Makary J, McClintock G, Fallot J, Broe M, Ahmadi N, Leslie S, Thanigasalam R. Video guide of robotic assisted laparoscopic prostatectomy post renal transplant: Unique considerations. Urology Video Journal, 2022. DOI: 10.1016/j.urolvj.2022.100169.
    • 

  • Steffens D, Karunaratne S, McBride K, Gupta S, Horsley M, Fritsch B. Implementation of robotic-assisted total knee arthroplasty in the public health system: A comparative cost analysis. International Orthopaedics, 2022. 46(3), p481-488. DOI: 10.1007/s00264-021-05203-1.
    • 

  • MacDessi S, Wernecke G, Bastiras D, Hooper T, Heath E, Lorimer M, Harris I, RASKAL Study Group. Robotic-assisted surgery and kinematic alignment in total knee arthroplasty (RASKAL study): A protocol of a national registry-nested, multicentre, 2×2 factorial randomised trial assessing clinical, intraoperative, functional, radiographic and survivorship outcomes. BMJ Open, 2022. 12(6), e051088. DOI: 10.1136/bmjopen-2021-051088.
    • 



Recent Presentations


    

  • McClintock G, Goolam A, Perera D, Downey R, Leslie S, Woo H, Ferguson P, Ahmadi N. Primary and post-chemotherapy robotic retroperitoneal lymph node dissection for metastatic testicular cancer. Royal Australasian College of Surgeons Annual Scientific Congress, Melbourne, Australia, 10-14 May 2021.
    • 

  • Cooper M. Multispeciality robotic endometriosis surgery. Invited presentation. Sydney Robot Institute, Virtual Webinar, 16 July 2021.
    • 

  • Boyle R, Franks D, Guzman M. Current technology in orthopaedics and tumour surgery: What are we actually capable of doing now? Surgical Robotics and Innovation Summit 2021, Virtual Webinar, 16 July 2021.
    • 

  • Georgevsky D, Duncan R, Taylor R, Yang V, Marren A, Varol N, Buckley V, Cooper M. The initial experience of robotic surgery for benign gynaecology at the Royal Prince Alfred Hospital. Australasian Gynaecological Endoscopy and Surgery Symposium, Brisbane, Australia, 8 October 2021.
    • 

  • Cao C. The advantages of robotic lung resection over VATS. Royal Australasian College of Surgeons Annual Scientific Congress, Virtual Webinar, 2-6 May 2022.
    • 

  • Broe M. Surgeon’s robotic surgical training program: What can nurses learn from this training model? Sydney Robotics and Innovation Summit, Sydney, Australia, 17-18 June 2022.
    • 

  • Cao C. Robotic sleeve resection. Sydney Robotics and Innovation Summit, Sydney, Australia, 17-18 June 2022.
    • 

  • Cooper M. Multispecialty robotic endometriosis surgery. Sydney Robotics and Innovation Summit, Sydney, Australia, 17-18 June 2022.
    • 

  • Pillinger S. Robotic training centre and program at RPAH and RoLaCaRT. Sydney Robotics and Innovation Summit, Sydney, Australia, 17-18 June 2022.
    • 

  • Yan T. Robotic mitral repair: String, ruler and bulldog. Sydney Robotics and Innovation Summit, Sydney, Australia, 17-18 June 2022.
    • 

  • Virk A. Robotic right radical nephrectomy with caval exploration. Society of Robotic Surgery, Video Abstract Presentation, Lake Buena Vista, United States of America, 30 June – 3 July 2022.
    • 



 


Orthopaedic Surgery


Summary of Program


The Orthopaedic Surgical Research Program was established to enhance academic, clinical surgical excellence and patient needs in musculoskeletal injuries and other conditions, to improve patient outcomes. There are five distinct research areas within the program: (i) robotics, (ii) lower limb arthroplasty, (iii) sarcoma, (iv) upper limb, and (v) foot & ankle. Committed to an evidence-based approach to patient education and appropriate care, the Orthopaedic Surgical Research Program strives to further the field through high quality research in each of these areas.


Since the program began in 2017, a comprehensive database (LOAD) has been established to capture every elective lower limb joint replacement performed at the Institute of Rheumatology and Orthopaedics (IRO) at RPAH, now containing over 3,500 patients. With the purchase of the Stryker MAKO Robotic System, the program has pursued research in the robotic arthroplasty space including the collection of patients reported outcomes from every patient undergoing robotic knee or hip arthroplasty (PRO-LOAD). More recently, the program has built a focus around patient education and surgical decision-making, for example through the development of patient decision aids.


Surgical Patient Flow




Surgical Volume




Patient Characteristics




Geographic Distribution of Patients




Highlights


    

  • Clinically relevant data for all hip and knee replacements performed at RPAH are captured in the Lower Limb Arthroplasty Database (LOAD). Since 2017 this database has now captured over 3,500 cases. Of these, 373 were performed within the 2021/2022 financial year, 159 being hip replacements and 214 being knee replacements.
    • 

  • The department has been supporting researched innovation in the area of arthroplasty through the purchase of the MAKO (Stryker) robot and recording of patient-reported outcomes which has been closely monitored by a Data Safety and Monitoring Board. The department has performed over 400 surgeries with this device, with 54 being performed in the 2021/2022 financial year.
    • 

  • In 2019 the orthopaedic department was awarded a grant of over $250,000 to support a higher degree research project investigating how to best support the decision-making process of patients considering knee replacement for end-stage osteoarthritis. The goal of this project is to design a decision aid for these patients.
    • 

  • The department is also supporting another higher degree research project investigating the role of dual mobility total hip replacement in the management of femoral neck fractures in older patients. The goal of this project is to evaluate if the use of dual mobility cups reduce the risk of adverse events, especially dislocation.
    • 

  • In 2022 the orthopaedic department commenced recruitment for the RASKAL Trial, a national registry-nested, multicentre randomised trial assessing clinical, intraoperative, functional, radiographic and survivorship outcomes, the first trial of its kind seeking to produce a high quality comparison between robotic assisted and computer navigated surgical approaches.
    • 



Recent Publications


    

  • Zadro J, Jones C, Harris I, Buchbinder R, O’Connor D, McCaffery K, Thompson R, Karunaratne S, Teng M, Maher C, Hoffmann T. Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: An international mixed-methods study. BMJ Open, 2021. 11(8), e054032. DOI: 10.1136/bmjopen-2021-054032.
    • 

  • Karunaratne S, Harris I, Trevena L, Horsley M, Solomon M. Observing the use of knee arthroplasty appropriateness tools in clinical practice: Do appropriateness criteria tools predict surgeon decision-making? Osteoarthritis and Cartilage, 2021. 29(9), p1275-1281. DOI: 10.1016/j.joca.2021.06.009.
    • 

  • Chahla J, Kunze K, LaPrade R, Getgood A, Cohen M, Gelber P, Barenius B, Pujol N, Leyes M, Akoto R, Fritsch B, Margheritini F, Rips L, Kautzner J, Duthon V, Togninalli D, Giacamo Z, Graveleau N, Zaffagnini S, Engbretsen L, Lind M, Maestu R, Von Bormann R, Brown C, Villascusa S, Monllau J, Ferrer G, Menetrey J, Hantes M, Parker D, Lording T, Samuelsson K, Weiler A, Uchida S, Frosch K, Robinson J. The posteromedial corner of the knee: An international expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surgery, Sports, Traumatology, Arthroscopy, 2021. 29(9), p2976-2986. DOI: 10.1007/s00167-020-06336-3.
    • 

  • Kim R, An V, Petchell J. Fibular fixation in mid and distal extra-articular tibia fractures: A systematic review and meta-analysis. Foot and Ankle Surgery, 2021. 17(21), p218-216. DOI: 10.1016/j.fas.2021.11.007.
    • 

  • Sayah S, Karunaratne S, Beckenkamp P, Horsley M, Hancock M, Hunter D, Herbert R, de Campos T, Steffens D. Clinical course of pain and function following total knee arthroplasty: A systematic review and meta-regression. The Journal of Arthroplasty, 2021. 36(12), p3993-4002. DOI: 10.1016/j.arth.2021.06.019.
    • 

  • Twiggs J, Miles B, Roe J, Fritsch B, Liu D, Parker D, Dickison D, Shimmin A, BarBo J, McMahon S, Solomon M, Boyle R, Walter L. Can TKA outcomes be predicted with computational simulation? Generation of a patient specific planning tool. Knee, 2021. 33, p38-48. DOI: 10.1016/j.knee.2021.08.029.
    • 

  • Elliott J, Shatrov J, Fritsch B, Parker D. Robotic-assisted knee arthroplasty: An evolution in progress: A concise review of the available systems and the data supporting them. Archives of Orthopaedic and Trauma Surgery, 2021. 141(12), p2099-2117. DOI: 10.1007/s00402-021-04134-1.
    • 

  • Klasan A, Putnis S, Yeo W, Myat D, Fritsch B, Coolican M, Parker D. Should sequential bilateral total knee arthroplasty be limited to patients younger than 80? A two-arm propensity matched study. Journal of Knee Surgery, 2021. 34(14), p1579-1586. DOI: 10.1055/s-0040-1712100.
    • 

  • Shatrov J, Murphy GT, Duong J, Fritsch B. Robotic-assisted total knee arthroplasty with the OMNIBot platform: A review of the principles of use and outcomes. Archives of Orthopaedic and Trauma Surgery, 2021. 141(12), p2087-2096. DOI: 10.1007/s00402-021-04173-8.
    • 

  • Bae S, Brnabic A, Crowe P, Carey-Smith R, Andelkovic V, Singhal N, Stalley P, Yip D, Desai J. Managing patients with advanced soft tissue sarcoma: Evolving landscape from an Australian perspective. Asia-Pacific Journal of Clinical Oncology, 2022. Online ahead of print. DOI: 10.1111/ajco.13706.
    • 

  • Steffens D, Karunaratne S, McBride K, Gupta S, Horsley M, Fritsch B. Implementation of robotic-assisted total knee arthroplasty in the public health system: A comparative cost analysis. International Orthopaedics, 2022. 46(3), p481-488. DOI: 10.1007/s00264-021-05203-1.
    • 

  • Fernando M, Horsley M, Jones S, Martin B, Nube V, Charles J, Cheney J, Lazzarini P, Australian Diabetes-Related Foot Disease Guidelines & Pathways Project. Australian guideline on offloading treatment for foot ulcers: Part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. Journal of Foot and Ankle Research, 2022. 15(1), e31. DOI: 10.1186/s13047-022-00538-3.
    • 

  • Strach M, Grimison P, Hong A, Boyle R, Stalley P, Karim R, Connolly E, Bae S, Desai J, Crowe P, Singhal N, Bhadri VA. Mesenchymal chondrosarcoma: An Australian multi-centre cohort study. Cancer Medicine, 2022. Online ahead of print. DOI: 10.1002/cam4.4849.
    • 

  • MacDessi S, Wernecke G, Bastiras D, Hooper T, Heath E, Lorimer M, Harris I, RASKAL Study Group. Robotic-assisted surgery and kinematic alignment in total knee arthroplasty (RASKAL study): A protocol of a national registry-nested, multicentre, 2×2 factorial randomised trial assessing clinical, intraoperative, functional, radiographic and survivorship outcomes. BMJ Open, 2022. 12(6), e051088. DOI: 10.1136/bmjopen-2021-051088.
    • 

  • Kim R, An V, Lee S, Khadra S, Petchell J. Overlapping surgery in arthroplasty: A systematic review and meta-analysis. Orthopaedics and Traumatology: Surgery Research, 2022. Online ahead of print. DOI: 10.1016/j.otsr.2022.103299.
    • 

  • Zadro J, Karunaratne S, Harris I, Jones C, O’Keeffe M, Ferreira G, Buchbinder R, McCaffery K, Thompson R, Maher C, Hoffmann T. The impact of a patient decision aid on intention to undergo surgery for subacromial pain syndrome: An online randomised controlled trial. Patient Education and Counselling, 2022. Online ahead of print. DOI: 10.1016/j.pec.2022.05.005.
    • 



Recent Presentations


    

  • Boyle R, Franks D, Guzman M. Current technology in orthopaedics and tumour surgery: What are we actually capable of doing now? Surgical Robotics and Innovation Summit 2021, Virtual Webinar, 16 July 2021.
    • 

  • Kim R, An, V, Lee, S, Khadra, S, Petchell, J. Overlapping surgery in arthroplasty: A systematic review and meta-analysis. Australian Orthopaedic Association Annual Scientific Meeting 2021, Virtual Webinar, 8-10 November 2021.
    • 

  • Boyle, R, Powell, G. The great debate: Old school vs new technology. Australia and New Zealand Sarcoma Association Annual Scientific Meeting 2021, Virtual Webinar, 5-6 November 2021.
    • 

  • Stalley, P. 3D tech revolutionises patient care: An innovative partnership between surgeons and the designers of custom-made prosthetics. Sydney Innovation and Research Symposium, Sydney Australia, 2-3 June 2022.
    • 

  • Fritsch, B. AI, data ownership and the future of orthopaedic research. Sydney Robotics and Innovation Conference 2022, Sydney, Australia, 17-18 June 2022.
    • 

  • Boyle, R. Reconstructing the most complex bone in the body using 3D printing. Sydney Robotics and Innovation Conference 2022, Sydney, Australia, 17-18 June 2022.
    • 

  • Harris, I. How do we innovate in the age of evidence-based medicine. Sydney Robotics and Innovation Conference 2022, Sydney, Australia, 17-18 June 2022.
    • 



 


Cancer Variation


Summary of Program


This program of work aims to identify variations in optimal care for patients diagnosed with cancer who require a surgical procedure. Through the application of high quality research methodologies, the program pursues the development of interventions to increase adherence to best practice guidelines. Crossing a range of surgical disciplines, including head and neck and colorectal cancer surgery, collaborations with local and international are fostered. These activities allow SOuRCe to partner with a broad spectrum of institutions and organisations.


    

  • Hide and seek project with the Cancer Council NSW: Since 2018, SOuRCe and RPAH have been involved Hide and Seek with Hereditary Cancer project led by the Cancer Council NSW. The project aims to utilise implementation science methods to ensure risk-appropriate completion of the tumour testing and referral pathway for patient with colorectal cancer at risk of Lynch syndrome. All seven phases of the project have been completed. The final results of this project are expected to be published at the end of 2022.
    • 

  • Cross-cultural adaptation and validation of the CCCQ-P: The outcomes of the translation and cross-cultural adaptation of the Cancer Care Coordination Questionnaire for Patients (CCCQ-P) into Arabic and Chinese languages has been completed and is currently available in the journal Patient Preference and Adherence. Further validation and psychometric testing of the instrument is expected to occur in the coming years.
    • 

  • Head and neck cancer pathways: This program of work has been running since 2017, and aims to investigate variations in pathways to diagnosis and treatment of head and neck cancer in NSW. This program is run in collaboration with clinicians at the Chris O’Brien Lifehouse, the Mid North Coast Cancer Institute, and the Northern NSW Cancer Institute.
    • 



Recent Publications


    

  • Young J, Venchiarutti R, Durcinoska I, Steffens D. Cross-cultural adaptation and pilot testing of the Cancer Care Coordination Questionnaire for Patients (CCCQ-P) in Chinese and Arabic languages. Patient Preference and Adherence, 2019. 13, p1791-1797. DOI: 10.2147/PPA.S221039.
    • 

  • Venchiarutti R, Clark J, Palme C, Shakespare T, Hill J, Tahir A, Dwyer P, Young J. Influence of remoteness of residence on timeliness of diagnosis and treatment of oral cavity and oropharynx cancer: A retrospective cohort study. Journal of Medical Imaging and Radiation Oncology, 2020. 64(2), p261-270. DOI: 10.1111/1754-9485.12990.
    • 

  • Steinberg J, Chan P, Hogden E, Tiernan G, Morrow A, Kang Y, He E, Venchiarutti R, Titterton L, Sankey L, Pearn A, Nichols C, McKay S, Hayward A, Egoroff N, Engel A, Gibbs P, Goodwin A, Harris M, Kench J, Pachter N, Parkinson B, Pockney P, Ragunathan A, Smyth C, Solomon M, Steffens D, Toh J, Wallace M, Canfell K, Gill A, Macrae F, Tucker K, Taylor N. Lynch syndrome testing of colorectal cancer patients in a high-income country with universal healthcare: A retrospective study of current practice and gaps in seven Australian hospitals. Hereditary Cancer in Clinical Practice, 2022. 20(1), e18. DOI: 10.1186/s13053-022-00225-1.
    • 

  • Venchiarutti R, Tracy M, Clark J, Palme C, Young J. Impact of targeted wording on response rates to a survey of general practitioners on referral processes for suspected head and neck cancer: An embedded randomised controlled trial. Journal of Primary Health Care, 2022. Online ahead of print. DOI: 10.1071/HC21095.
    • 

  • Venchiarutti R, Tracy M, Clark J, Palme C, Young J. Geographic variation in referral practices for patients with suspected head and neck cancer: A survey of general practitioners using a clinical vignette. Australian Journal of Rural Health, 2022. Online ahead of print. DOI: 10.1111/ajr.12859.
    •