Comparing operative techniques for non-palpable breast tumours: Wire-guided localisation vs LOCaliser

Introduction: Wire-guided localisation (WGL) has been the standard operative technique for non-palpable breast tumours. LOCaliser is an alternative method, with a clinical effectiveness that may be equal to the standard while providing additional benefits regarding the patient experience. Method(s): A single-centre, retrospective study of WGL vs LOCaliser from January 2020 to December 2021. We collected demographic and outcome data from electronic records. The primary outcome was rates of complications, this included seromas, haematomas, pain and re-excisions. Secondary outcomes included operative time. Result(s): 21 WGL and 16 LOCaliser patients were identified. The average age was similar between the two groups (62 vs 61;P=0.291). There were fewer complications in the LOCaliser group, however without statistical significance (1 vs 5;P=0.206). The LOCaliser group had less re-excisions (1 vs 5;P=0.206), with 3 of 5 patients requiring 2 margins to be re-excised in the WGL group. There was no difference in the operative time between the two groups (107 minutes vs 104 minutes;P=0.070), sub-group analysis was not done to compare axillary node clearances and sentinel lymph node biopsies. Conclusion(s): LOCaliser is as effective if not superior to WGL when measuring clinical outcomes. The data did not demonstrate statistical significance, however demonstrated differences which could become significant with larger patient cohorts. LOCaliser prevented the need for pre-operative procedures, which was particularly important during the COVID-19 pandemic as it reduced patient exposure and hospital attendances prior to surgery. A larger scale audit and assessing patients' experiences by collection patient reported outcomes measures (PROM) would be beneficial. Copyright © 2022

Suspected appendicitis and COVID-19, a change in investigation and management-a multicentre cohort study.

PURPOSE: The COVID-19 pandemic has reformed global healthcare delivery. On 25 March 2020, Intercollegiate guidelines were published in the UK to promote safe surgical provision during the COVID-19 outbreak advocating non-operative management or avoidance of laparoscopy when surgery is essential. The effects of this on the investigation and management of appendicitis remain unknown. METHODS: We performed a multicentre, prospective, observational study from the start of the new guidelines to the 6th of May 2020. We included all patients referred to surgical teams with suspected appendicitis. A recent historical cohort was identified for comparison. The primary outcome was the impact of the COVID-19 pandemic on the use of non-operative management in appendicitis. Secondary outcomes included imaging, negative appendicectomy rate (NAR), length of stay (LOS) and 30-day complications. RESULTS: A total of 63/164 (38%) patients compared to 79/191 (41%) were diagnosed with appendicitis before and after the guidelines were introduced (p = 0.589). CT scanning increased (71/164 vs 105/191; p = 0.033) while ultrasound scanning decreased (71/164 vs 62/191; p = 0.037). Appendicitis was more likely to be managed non-operatively (11/63 vs 51/79; p < 0.001) and, of those managed surgically, with an open approach (3/52 vs 26/28 p < 0.001). The NAR also reduced (5/52 vs 0/28; p = 0.157). LOS was shorter in non-operatively managed patients (1 day vs 3 days; p < 0.001) without a difference in complications (10/51 vs 4/28; p = 0.760). CONCLUSION: Introduction of the guidelines was associated with changes in practice. Despite these changes, short-term complications did not increase and LOS decreased. Questions remain on the longer-term complication rates in non-operatively managed patients.