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HA, IM, and MC were predictors of malignancy in Bethesda III nodules. In addition, the negative predictive value for any of these three criteria was high; a nodule that lacks all of these three criteria is thus unlikely to be malignant.

Background: The pathogenesis of seroma formation following axillary dissection continues to be poorly understood, although it seems that the greater the surgical disruption of the axilla, the higher the incidence of seroma and lymphoedema. We have previously described the laminated, three-dimensional structure of the clavipectoral fascia (CPF) that is evident during axillary ultrasonography and dissection . We propose that reconstituting the CPF reduces dead space, partially restores pressure gradients and facilitates collateralization to improve lymphatic flow, thereby reducing the incidence of seromas. Herewith, is a description of our technique for reconstitution of the CPF and our experience thus far. Method: Technique: Following mastectomy or breast conservation surgery, the lateral border of pectoralis major is defined. Here, the medial, anterior laminae of the CPF are identified but not incised. Once the anterior extent of the CPF is displayed, a longitudinal incision is made through the midpoint of the CPF to access the axillary contents. If there is a substantial axillary tail, then the CPF is incised along the perimeter of the tail to include intra-mammary lymph nodes. A loose areolar tissue plane is encountered; the edges of the CPF are grasped and elevated and this areolar tissue plane developed by blunt and sharp dissection. Medially, this loose areolar tissue plane leads directly to a posterior gutter, and the long thoracic nerve on serratus anterior is identified and preserved. Superiorly, a deeper lamina of the CPF along the inferior border of the axillary vein has to be incised to find the thoracodorsal nerve. Identification of the intercostobrachial nerves is standard, as is the lateral dissection. Identification of the long thoracic nerve and thoracodorsal bundle results in definition of a vertical sheet, ‘the interneural tissue’. This can be grasped between the thumb and index finger and is excised en bloc. This tissue contains fat, lymph nodes and lymphatic vessels and is lined by thin fascial layers that we consider related to the CPF3. At this stage, the anterior laminae of the CPF and axilla are carefully palpated for any residual nodes. After haemostasis, the CPF is reconstituted with a running, absorbable ‘lymphostatic’ suture. No drain is placed in the axilla. Results: Between 2012 – 2015, 64 patients have undergone axillary dissection with reconstitution of the CPF in our unit.. The average age was 54 years (range 29-87 years). An average of 12 nodes were procured (range 2-26 nodes). Only 5 women (8%) required seroma aspiration. Conclusion: We have dispensed with axillary drains in those who have had reconstitution of the CPF and only a minority of our patients required axillary seroma aspiration. We believe this technique should be given consideration to decrease the use of drains following axillary dissection. Citation Format: Meredith IC, Popadich A, Mouat CH, Barrett K, King B. Endofascial axillary lymphadenectomy – Towards a drainless protocol. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-03.

Purpose  Oesophagectomy is associated with considerable morbidity, mortality and poor survival of patients who have undergone oesophagectomy for oesophageal carcinoma. Numerous studies have examined the impact of hospital volume on early mortality, most demonstrating a strong inverse relationship between operative mortality and hospital case volume. This study looks at the morbidity, mortality and 2‐year survival of patients following oesophagectomy at Dunedin hospital, a low volume centre, and comparing it to high volume centres. Methods  A retrospective analysis of all patients who had elective oesophagectomy between 1995 and 2004. Otago Surgical Audit database, patient management system database (OraCare) as well as operating theatre database were used. Results  40 patients were identified, which had either transhiatal or Ivor‐Lewis procedure. 50% had pre‐op chemotherapy and 33% pre‐op radiotherapy. 65% had adenocarcinoma, 10% squamous cell carcinoma and 15% had Barrett’s with severe dysplasia. The mortality at Dunedin was 5%. Complications were: respiratory 37.5%, leak 10%, wound 22.5%, oesophageal stricture 2.5% and chylothorax 2.5%. Median length of stay was 15 days (11–94). Median survival of patients with oesophageal carcinoma was 26 months. Median survival of node negative patients was 34.5 months and node positive patients 14 months. Conclusion  Prognosis for patients with node‐positive disease continues to be poor despite oesophagectomy. The complication rates and in‐hospital mortality at Dunedin are similar to high volume centres. This study shows that patients undergoing oesophagectomy at low volume hospital do not have increased risk of operative mortality.

Background Over the last 2 decades, outcomes for oesophageal cancer have improved due to advances in surgical and oncological practice. Optimizing outcomes by centralization of oesophagectomy to high‐volume centres has been observed. The aim of this study was to establish if technical and oncological outcomes after oesophagectomy in southern New Zealand are comparable to recent benchmarks. Methods Consecutive patients undergoing oesophagectomy for cancer and benign pathology at Dunedin Hospital from 1995 to 2019 were prospectively audited. For malignant cases, histology was obtained retrospectively along with details of neo‐adjuvant and adjuvant therapy. The primary outcome was disease‐specific survival, stratified by time, resection margin, and TNM staging. Secondary outcomes included mortality and morbidity of oesophagectomy. Complications were graded using the Clavien‐Dindo classification. Results Oesophagectomy was performed in 108 patients, and 99 patients had surgery for oesophageal malignancy. The median survival was 35.3 (95% confidence interval (CI) 30.0–93.4) months and the 5‐year survival overall was 41.7%. Comparing survival in patients undergoing oesophagectomy up to 2006 and afterwards showed an improvement in 5‐year survival (30.3%, 95% CI (14.2–60.0) versus 47.8%, 95% CI (32.5, not reached), respectively, P = 0.041). There were two perioperative deaths (1.8%), six clinical anastomotic leaks (5.5%), four anastomotic strictures (3.7%) and five chylothoraces (4.6%). Conclusion This 25‐year survey of oesophagectomy in southern New Zealand audits the results of a low volume centre, where a variety of neo‐adjuvant treatments have been used. Despite this, perioperative morbidity, mortality and survival are comparable to those achieved by international high‐volume centres.

We describe a case of a 46-year-old woman who was treated initially for a presumed non-lactational breast abscess.As symptoms did not subside with conservative management a major duct excision was conducted and histology revealed an infiltrating syringomatous adenoma.She underwent further surgery to achieve clear margins and the tumour is the largest reported to date.These are benign, infiltrating lesions and are rare with less than 40 cases reported in the literature.Patients usually present with a retro-areolar mass and adjacent skin and nipple changes. Radiologically they are difficult to differentiate from breast cancer and diagnosis is largely confirmed through histologic and immunohistochemical analysis.Treatment is with local excision to achieve clear margins as recurrence rates are high with residual tumour. Keywords: Syringomatous adenoma; Nipple; Breast abscess Case Report:Mrs A, a 46-year-old woman was initially admitted acutely to hospital with a presumed non-lactational breast abscess in the central left breast and commenced on intravenous antibiotics.She had been assessed nine years previously by a breast surgeon for left nipple discomfort that was thought to be due to duct ectasia. She was offered a duct excision at this time but declined. She underwent needle aspiration and purulent appearing material was obtained however laboratory analysis did not identify causative bacteria. She experienced clinical improvement and was discharged home.At subsequent outpatient clinic follow up the area of induration around the left nipple remained along with a small sub-areolar collection on ultrasound, which persisted despite antibiotics and serial aspiration.Ultrasound did not suggest features concerning for malignancy. As the nipple changes failed to settle the patient was offered left major duct excision. Histology demonstrated appearances suggestive of infiltrating syringomatous adenoma (ISA) of the nipple.The lesion was 45 × 25 mm, which appears to be the largest case of ISA reported in the literature. As margins were positive, the decision was made for re-excision with complete excision of the left nipple areola complex. Histology confirmed that the residual ISA had been excised with negative margins.