Outcomes following therapeutic lymphadenectomy for Stage III malignant melanoma in a single unit.

BACKGROUND: Malignant melanoma is the fourth most common cancer in New Zealand. Surgery is the only treatment modality that can achieve high cure rates for regional disease, but is associated with high complication rates. Our study documents the morbidity associated with regional lymphadenectomy; audits nodal harvest numbers and considers nodal harvest targets. METHODS: We retrospectively reviewed regional lymphadenectomies for Stage III melanoma at a single tertiary centre from 2004 to 2014. Data was collected on patient demographics, site of operation, number of lymph nodes recovered, all complications within six months of surgery, loco-regional recurrence, distal progression and five-year survival. We also used key performance indicators (KPI) to assess the quality of dissection. RESULTS: A total of 219 lymphadenectomies were carried out. Forty-three percent of all patients experienced at least one complication. This was markedly higher for those undergoing a groin dissection. Recurrence, progression and survival rates did not vary between nodal basins. There was a mean of 31.6, 17.6 and 10.9 nodes recovered from neck, axillary and groin dissection groups respectively. Our KPIs were achieved in 80%, 86.6% and 90% of cases and resulted in a significant improvement in recurrence and progression rates. CONCLUSION: Lymphadenectomy has a high risk of post-operative complications, especially for groin dissections. Quality of lymphadenectomy can be assessed by monitoring nodal harvest numbers, and achieving nodal harvest targets provides significant prognostic information. We support the development of national tumour standards, including key performance indicators, for management of Stage III melanoma.

The cost of major head and neck cancer surgery.

AIM: This study quantified the cost of major head and neck cancer (HNC) surgery. METHODS: Consecutive patients undergoing major HNC surgery between July 2007 and June 2012 were identified from our head and neck database. Patient demographics, tumour type, site, stage and types of resection and reconstruction, length of stay and surgical complications occurring within six months of initial surgery were retrospectively analysed. The actual cost of initial surgical treatment and hospital income were calculated. RESULTS: Two hundred and forty-five patients underwent major HNC surgery, most commonly for mucosal squamous cell carcinoma (SCC) and metastatic and/or locally advanced cutaneous SCC. Neck dissection and parotidectomy were the commonest resection procedures and free flaps the commonest reconstructive procedures performed. Forty-two patients developed surgical complications within six months of the initial major HNC surgery. Over the five-year period, surgery cost a total of NZ$5,130,639.00, averaging NZ$20,941.38 per patient, not including costs such as incidentals, while the hospital received NZ$4,976,559.61 averaging NZ$20,229.91/patient. On average, oral cavity cancer, metastatic and/or locally advanced skin cancer, and skull base cancer cost NZ$22,694.72/patient, NZ$17,373.64/patient and NZ$47,295.95/patient, respectively. CONCLUSION: Calculated hospital income marginally covered the actual cost of major HNC surgery, which places substantial financial burden on the hospital. The anatomic site of the tumour determines the cost of treatment.

A study of acute otitis externa at Wellington Hospital, 2007-2011.

BACKGROUND: Acute otitis externa (AOE) is a common inflammatory condition affecting the external ear that occasionally presents with persistent, severe pain, which may be unresponsive to first-line therapy and require assessment and treatment in the hospital setting. AIMS: To identify the microorganisms responsible for cases of otitis externa presenting to Wellington Hospital, New Zealand, over a five-year period between 2007 and 2011. We also aim to evaluate current management of this condition and to recommend future treatment options. METHOD: A five-year retrospective study, with data obtained from case notes and electronic records for all patients presenting with otitis externa to Wellington Hospital between 2007 and 2011. RESULTS: Of three hundred and forty-seven cases identified, 144 were included in the study. Pseudomonas aeruginosa (P. aeruginosa) was the most common organism (46.5 per cent), while Staphylococcus aureus (S. aureus) was the second most common (31.9 per cent). Most patients received appropriate topical treatment. However, a significant number were treated with systemic antibiotics alone without adverse outcomes. CONCLUSION: Pseudomonas aeruginosa is the most common microbe causing acute otitis externa in patients that require hospital level management in Wellington, New Zealand. In most cases, patients received appropriate topical therapy; however, it appears a large number received systemic antibiotic therapy without topical treatment. We recommend broad-spectrum topical antimicrobial therapy in all patients with uncomplicated AOE and culture-sensitive topical treatment with consideration of systemic antimicrobials for severe AOE requiring hospital admission.