Background:Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this population remains unknown. Our objective was to conduct a systematic review of contemporary literature on the use of heparin thromboprophylaxis following major open pelvic surgery for malignancy, comparing the efficacy and safety of extended duration to inpatient treatment. Methods: A study protocol describing search strategy and inclusion and exclusion criteria was developed and registered with PROSPERO. A literature review was conducted in accordance with the protocol. Results: Literature review identified only 4 studies directly comparing extended and inpatient duration prophylaxis, with a combined population of 3198 and 3135 patients for VTE rate and bleeding events, respectively. Despite many studies reporting lower VTE rates in patients receiving extended prophylaxis, no statistically significant difference in rates of postoperative VTE (p = 0.18) or bleeding complications (p = 0.43) was identified between patients receiving extended duration prophylaxis and those receiving inpatient only prophylaxis. Conclusion: On the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy. This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated.

While a prolonged admission and multiple operations are expected, early diagnosis and aggressive multimodal treatment may result in a significantly better survival outcome than those quoted in previous literature.

Objective To review the published literature evaluating the efficacy and safety of buccal mucosa ureteroplasty. Methods A systematic literature review was carried out using a protocol devised a priori. The review was registered with the Joanna Briggs Institute. Results were scrutinized and full text of all relevant articles was obtained for review. Results A systematic search resulted in 1092 articles, with scrutiny resulting in 1079 exclusions. Two additional articles were identified from references, resulting in a total of 15 included studies containing a total of 72 buccal mucosal ureteroplasty procedures. A total of 34 cases were carried out using the open approach, and 38 were carried out using the robot assisted approach. The overall reported success rate was reported to be 66 out of 72 (91.6%), being 32 out of 34 (94.1%) and 34 out of 38 (89.5%) open and robotic cases, respectively. The complication rate was reported in 60 cases, being 15 out of 60 (25%) for all complications, with a 5% (3/60) rate for complications graded as Clavien–Dindo score ≥3. Conclusions Buccal mucosa ureteroplasty appears to have high success rates and low rates of serious complications in both open and robot assisted approaches. However, the current available literature is limited to 72 cases, and further studies with larger patient populations and ongoing longitudinal review are warranted.

BackgroundTo examine the effect of intra-operative cell salvage (ICS) in open radical prostatectomy.MethodsIn this retrospective cohort study, all patients undergoing open radical prostatectomy for malignancy at our institution between 10/04/2013 and 10/04/2017 were enrolled. Patients were grouped and compared based on whether they received ICS. Primary outcomes were allogeneic transfusion rates, and disease recurrence. Secondary outcomes were complications and transfusion-related cost.ResultsFifty-nine men were enrolled; 30 used no blood conservation technique, while 29 employed ICS. There were no significant differences between groups in age, pre- or post-operative haemoglobin, Charlson comorbidity index, operation duration or length of stay. Tumour characteristics were also similar between groups, including pre-operative prostate specific antigen, post-operative Gleason score, T-stage, nodal status and rates of margin positivity. Compared with controls, the ICS group had longer follow up (945 vs. 989 days; P=0.0016). The control and ICS groups were not significantly different in rates of tumour recurrence (6 vs. 3 patients; P=0.30) or complications (10 vs. 5 patients; P=0.16). While the proportion of patients receiving allogenic transfusion was similar (9 vs. 6 patients; P=0.41), fewer red blood products transfused (40 vs. 12 units) meant transfusion related costs were lower in ICS patients (AUD $47,666 vs. $37,429).ConclusionsICS reduced transfusion related costs, without affecting allogeneic transfusion rates, tumour recurrence or complication rates. These findings extend the literature supporting ICS in oncological surgery. Prospective randomised studies are needed to confirm the existing level III evidence.