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Indraratna P.,St George Hospital | Indraratna P.,University of New South Wales | Indraratna P.,Collaborative Research CORE Group | Cao C.,University of New South Wales | Cao C.,Collaborative Research CORE Group
Australian Prescriber | Year: 2014

Ticagrelor and prasugrel are antiplatelet drugs that are alternatives to clopidogrel in acute coronary syndrome. Their advantages include reduced rates of ischaemia and stent thrombosis.The risk of major bleeding is likely to be higher with prasugrel compared to clopidogrel. Intracranial haemorrhage appears to be slightly more common with ticagrelor than with clopidogrel, and it can also cause dyspnoea and ventricular pauses early in treatment.When patients taking prasugrel or ticagrelor require surgery, perioperative management is challenging. The treating cardiologist should be consulted whenever treatment cessation is considered. © 2014 Australian Government Publishing Service. All rights reserved. Source

Chan D.L.,University of New South Wales | Chan D.L.,Collaborative Research CORE Group | Morris D.L.,University of New South Wales | Chua T.C.,University of New South Wales | Chua T.C.,Collaborative Research CORE Group
Surgical Oncology | Year: 2013

Background: Primary hepatectomy is an accepted treatment for primary hepatocellular carcinoma (HCC) with good long-term survival, but high rates of recurrence. This review aims to evaluate the safety and efficacy of repeat hepatectomy for recurrent HCC after initial hepatectomy. Methods: Electronic searches identified 22 eligible studies comprising of 1125 patients for systematic review. Studies with >10 patients, adopting repeat hepatectomy treatment for recurrent HCC initially treated with hepatectomy were selected for inclusion. A predetermined set of data comprising demographic details, morbidity and mortality indices and survival outcomes were collected for every study and tabulated. Results: Majority of patients selected for repeat hepatectomy had Child-Pugh A (median 94%, range 40-100). Intrahepatic recurrence occurred at a median of 22.4 (range 12-48) months in this patient cohort with single nodule recurrences comprising of 70% of cases. The median mortality rate was 0% (range 0-6%). Prolonged ascites was observed in a median of 4% (range 0-32%), bleeding in 1% (range 0-9%), bile leak in 1% (range 0-6%) and liver failure in 1% (range 0-2%). The median disease-free survival was 15 (range 7-32) months and median overall survival was 52 (range 22-66) months. Median 3-year and 5-year survival was 69% (range 41-88%) and 52% (range 22-83%) respectively. Recurrences occurring 12-18 months after initial hepatectomy was consistently associated with improved survival. Conclusion: Synthesized data from observational studies of repeat hepatectomy suggests that this treatment approach for recurrent HCC is safe and achieves long-term survival. Standardization of criteria for repeat hepatectomy and a randomized trial are warranted. © 2013 Elsevier Ltd. All rights reserved. Source

Cao C.,Collaborative Research CORE Group | Cao C.,University of New South Wales | Tian D.H.,Collaborative Research CORE Group | Wolak K.,Collaborative Research CORE Group | And 6 more authors.
Chest | Year: 2014

BACKGROUND: Lobectomy for non-small cell lung cancer (NSCLC) can be performed either through open thoracotomy or video-assisted thoracoscopic surgery (VATS). To improve the understanding of current attitudes of the thoracic community toward VATS lobectomy, the Collaborative Research Group conducted the Cross-sectional Survey on Lobectomy Approach (X-SOLA) study. We surveyed a large cohort of lobectomy-performing thoracic surgeons to examine their adoption of VATS lobectomy and their opinions of this technique vs conventional open thoracotomy. METHODS: Participants included thoracic surgeons identified through an international index search from the Web of Science and the cardiothoracic surgery network. A confidential questionnaire was e-mailed in June 2012. Nonresponders were given two reminder e-mails at monthly intervals. RESULTS: The questionnaire, completed by 838 thoracic surgeons within a 3-month period, identified 416 surgeons who only performed lobectomy through open thoracotomy and 422 surgeons who performed VATS or robotic VATS. Of those who performed VATS, 95% agreed with the definition of "true" VATS lobectomy according to the Cancer and Leukemia Group B trial. Ninety-two percent of surgeons who did not perform VATS lobectomy responded that they were willing to learn this technique, but were hindered by limited resources, exposure, and mentoring. Both groups agreed there was a need for VATS lobectomy training in thoracic residency programs and in standardized workshops. CONCLUSIONS: X-SOLA represents the largest cross-sectional report within the thoracic community to date, demonstrating the penetration of VATS lobectomy for NSCLC internationally. From our study, we were able to identify a number of obstacles to broaden the adoption of this minimally invasive technique. © 2014 American College of Chest Physicians. Source

Cao C.,Collaborative Research CORE Group | Cao C.,Baird Institute for Applied Heart and Lung Surgical Research | Manganas C.,St George Hospital | Ang S.C.,Collaborative Research CORE Group | And 3 more authors.
Interactive Cardiovascular and Thoracic Surgery | Year: 2013

Objectives This meta-analysis aimed to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) with open thoracotomy for propensity score-matched patients with early-stage non-small cell lung cancer (NSCLC). Methods Four relevant studies with propensity score-matched patients were identified from six electronic databases. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization. Results Results indicate that all-cause perioperative mortality was similar between VATS and open thoracotomy. However, patients who underwent VATS were found to have significantly fewer overall complications, and significantly lower rates of prolonged air leak, pneumonia, atrial arrhythmias and renal failure. In addition, patients who underwent VATS had a significantly shorter length of hospitalization compared with those who underwent open thoracotomy. Conclusions In view of a paucity of high-level clinical evidence in the form of large, well-designed randomized controlled trials, propensity score matching may provide the highest level of evidence to compare VATS with open thoracotomy for patients with NSCLC. The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization. © 2012 The Author. Source

Cao C.,Collaborative Research CORE Group | Cao C.,Baird Institute for Applied Heart and Lung Surgical Research | Manganas C.,St George Hospital | Horton M.,St George Hospital | And 7 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2013

Introduction: The efficacy of coronary artery bypass graft (CABG) surgery for patients with ischemic heart disease is dependent on the patency of the selected conduit. The left internal thoracic artery is considered to be the best conduit for CABG. However, the preferred conduit between the radial artery (RA) and saphenous vein (SV) remains controversial. The present meta-analysis aims to establish the current level IA evidence on patency outcomes comparing the RA and SV. Methods: Electronic searches were performed using 6 databases from their inception to March 2012. Two reviewers independently identified all relevant randomized controlled trials (RCTs) comparing patency outcomes of RA and SV grafts after CABG. Data were extracted and meta-analyzed according to angiographic end points at specified follow-up intervals. Results: Five relevant RCTs were identified for inclusion in the present meta-analysis. Angiographic results indicated that the RA was significantly more likely to be completely patent and less likely to be associated with graft failure or complete occlusion at 4 years' follow-up and beyond. However, the RA was significantly more likely to be associated with string sign at 1 year of follow-up. Conclusions: While acknowledging the limitations of heterogeneous surgical techniques, results from the present meta-analysis suggest potential superiority of the RA compared with the SV at midterm angiographic follow-up. However, the increased incidence of string sign associated with the RA is of potential clinical concern. Further research should be directed at correlating angiographic findings of string sign and graft failure to clinical symptoms and major adverse cardiac and cerebrovascular events at long-term follow-up. © 2013 by The American Association for Thoracic Surgery. Source

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