Long-Term Health-Related Quality of Life Outcomes Following Thyroid Surgery for Malignant or Benign Disease: Deficits Persist in Cancer Survivors Beyond Five Years.

BACKGROUND: Thyroid cancer diagnoses are increasing and treatment can lead to significant morbidity. Long-term health-related quality of life (HRQoL) in thyroid cancer is understudied and lacks reference populations. This study compares long-term HRQoL between patients with thyroid cancer or benign disease, following thyroid surgery. METHODS: Patients undergoing thyroidectomy between 2000 and 2017 were identified from a pathology database. 696 participants (278 malignant, 418 benign) were invited to complete a validated disease-specific HRQoL tool, City of Hope-Thyroid Version. Propensity scores were used to adjust for demographic and clinical differences between cohorts. RESULTS: 206 patients (102 malignant, 104 benign), 71% female, returned surveys a median of 6.5 (range 1-19) years after thyroidectomy. Of the cancer cohort, 95% had differentiated thyroid cancer and 83% remained disease-free. There were no significant differences in overall HRQoL scores between groups. In comparison to the benign cohort, cancer patients showed a significant detriment in the social subdomain score (OR 0.10-0.96, p = 0.017) but not in other subdomains (physical, psychological, spiritual). Female gender, increasing BMI and cancer recurrence were significantly associated with decreased overall HRQoL. Compared to the benign cohort, cancer patients reported more personal and family distress associated with diagnosis and treatment, increased future uncertainty, poorer concentration and greater financial burden. CONCLUSION: Although no difference in overall HRQoL was found between patients undergoing thyroidectomy for benign or malignant disease, detriments in social well-being may persist many years after surgery. Thyroid cancer patients and their families may benefit from increased supports around the time of diagnosis and treatment.

Patient perceptions of surgical telehealth consultations during the COVID 19 pandemic in Australia: Lessons for future implementation.

INTRODUCTION: Prior studies of telehealth report high levels of patient satisfaction, but within carefully selected clinical scenarios. The COVID-19 pandemic led to telehealth replacing face-to-face care for many surgical consultations across a variety of situations. More evidence is needed regarding patient perceptions of telehealth in surgery, in particular, exploring barriers and facilitators associated with its sustained implementation beyond the pandemic. METHODS: Survey invitations were emailed to a convenience sample of surgical patients by their surgeon following a telehealth consultation during the COVID-19 pandemic. Surgeons were recruited from a sample (n = 683) who completed a survey on telehealth (distributed via email to all Australian Fellows of the Royal Australasian College of Surgeons). Mixed methods analysis was performed of the patient survey data. RESULTS: A total of 1166 consultations were captured: 50% routine reviews, 17% initial appointments and 20% post-operative reviews. Video-link was used in 49% of consultations. The majority of patients (94%), were satisfied with the quality of their surgical telehealth consultation and 75% felt it delivered the same level of care as face-to-face encounters. Telehealth was convenient to use (96%) and led to cost savings for 60% of patients. When asked about future appointment preferences after the pandemic, 41% indicated they would prefer telehealth (24% video-link and 17% telephone) over face-to-face appointments. There was a perception by patients that telehealth consultation fees should be less than face-to-face consultation fees. CONCLUSION: Patient satisfaction with surgical telehealth consultations is high. Barriers to more widespread implementation include financial, clinical appropriateness, technical and confidentiality concerns.

Metastatic renal cell carcinoma presenting as jaundice with biliary and gastric outlet obstruction. A case report.

Renal cell carcinoma (RCC) can be an aggressive malignancy that has a propensity to spread to atypical locations, most commonly to lung, bone, lymph node. RCC presenting as obstructive jaundice with gastric outlet obstruction has rarely been cited in literature. This study presents a case of advanced RCC in a patient with obstructive jaundice and associated gastric outlet obstruction from a large right renal RCC with malignant retrocaval lymphadenopathy invading the duodenum and distal common bile duct. The patient underwent anterograde stenting of the biliary system via a percutaneous transhepatic cholangiography and an insertion of a duodenal stent. Immunotherapy was commenced and the patient was discharged home. This case highlights the importance of a multi-disciplinary team approach to the management of a complex surgical patient.

Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: lessons learnt.

BACKGROUND: The COVID-19 pandemic has led to the rapid and widespread adoption of telehealth. There is a need for more evidence regarding the appropriateness of telehealth, as well as greater understanding of barriers to its sustained use within surgery in Australia. METHODS: A survey weblink was sent via email to 5558 Australian Fellows of the Royal Australasian College of Surgeons in August 2020. A single reminder email followed this 2 weeks later. Mixed methods analysis was performed of the survey data. RESULTS: There were 683 (12.3%) complete responses. Telehealth (telephone or video-link) consultations were undertaken by 638 (85%) respondents as a result of the pandemic, with 583 (85%) of these expressing a desire for continued access to telehealth. Seventy-seven percent of respondents felt that a satisfactory level of care could be delivered via telehealth in half or more consultations. However, only 38% of respondents felt that quality of care was equivalent comparing telehealth and face-to-face consultations, with the inability to perform a clinical examination a frequent concern. The majority agreed that telehealth was appropriate for clinical meetings and arranging investigations (91% each), whereas only 22% and 17%, respectively, felt telehealth was an appropriate means to break bad news and manage conflict. Medicolegal, technical and financial concerns were raised as prominent barriers to the sustained use of telehealth. CONCLUSION: Surgeons show good insight into the clinical appropriateness and limitations of telehealth. Medicolegal, technical and financial barriers need to be addressed in order to fully utilize the benefits of telehealth into the future.

Experience With the Axillary Artery as an Arterial Cannulation Site in Patients With Acute Type A Aortic Dissection.

BACKGROUND: The optimal arterial cannulation site in patients undergoing surgical management of acute type A aortic dissection (ATAAD) remains controversial. The axillary artery is rarely involved in the dissection process, provides antegrade flow in the descending aorta and minimises intraoperative malperfusion. The purpose of this study is to evaluate a single surgeon's experience of axillary artery cannulation for ATAAD repair. METHODS: All consecutive patients over a 15-year period having surgical repair of ATAAD were included in this study. RESULTS: There were 55 patients with a mean age of 67years. The most common risk factors were hypertension (83.6%), connective tissue disease (7.3%) and a bicuspid aortic valve (7.3%). Axillary artery cannulation was performed on 50 patients (90.9%) and was contraindicated in the remaining five patients. Forty-nine patients survived to 30days with a 10.9% 30-day mortality rate. There was one confirmed stroke (1.8%) and no new malperfusion noted postoperatively. There were no major axillary artery complications or new dissection related to cannulation. We attribute these results, which are lower than those reported in the International Registry of Acute Aortic Dissection (IRAD) database, to axillary artery cannulation providing antegrade flow in the descending aorta from the outset and reducing intraoperative malperfusion. We believe this technique offers a cerebroprotective advantage and also facilitates selective antegrade cerebral perfusion (SACP) when aortic arch replacement is required. CONCLUSION: We believe the axillary artery is the ideal cannulation site of ATAAD and helps to reduce mortality and neurological complications in this high-risk group of patients.