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Background This study aimed to examine the presentation, treatment, and long‐term outcomes of patients with gallbladder carcinoma (GBC) managed in a surgical unit of an Australian tertiary referral hospital of a 19‐year period. Methods A retrospective review of prospectively collected data of patients with GBC managed in the Royal North Shore Upper GI Surgical department from October 1999 to March 2018. Results A total of 104 patients with GBC were identified: 36 patients underwent palliative treatment, 61 patients with gallbladder adenocarcinoma underwent resection with curative intent. Seven patients were excluded. ‘Simple cholecystectomy’ was undertaken in eight patients, ‘standard radical cholecystectomy’ in 37 and ‘extended radical resection’ in 16. The median survival in these patients was 35 months (95% confidence interval (CI) 21.29–55.10), with a median follow up of 60 months (95% CI 38.18–78.39). This compares with an overall median survival of only 4.00 months (95% CI 2.79–6.24) in patients who did not undergo a potentially curative resection. Independent predictors of poor long‐term survival included an elevated preoperative serum tumour marker, advanced tumour stage (T3/T4) or node positive disease (N1/N2). Conclusion The biology and stage of GBC at presentation are major factors in determining patient outcome. There is a need for better pre‐ and post‐operative predictors to improve risk stratification, and these are likely to be in the form of molecular markers. Although the focus of surgery should be to ensure an R0 resection, patients with advanced stage disease need to be carefully selected for surgical intervention, and ideally should be managed by a multidisciplinary team in a specialist centre.

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Background: The complex and critically unwell upper gastrointestinal bleeding (UGIB) patient is a common emergency presentation in Australia. Managed medically and endoscopically by rural general surgeons in rural and remote Australian hospitals which lack a gastroenterology service, this can be ameliorated by clear evidence-based guidelines. Methods: A single-centre retrospective review of adult patients who underwent emergency gastroscopy for UGIB at the Mackay Base Hospital, January 2019 to January 2022. Detailed patient data from the assessment, resuscitation, time to endoscopy, endoscopic intervention, and outcomes were compared against key international gastroenterology society safety and quality standards for UGIB. Results: Two hundred patients had a comprehensive initial assessment and resuscitation with PRBC (39%), anticoagulation reversal (18%), pantoprazole infusion (81%), tranexamic acid (10.50%) and octreotide (16.50%). Risk scores were calculated retrospectively as none were documented. Time-to-endoscopy targets were achieved in over 70% of variceal or non-variceal UGIB patients. Bleeding was found in 59.50% of patients but 63% of patients did not require a manoeuvre to stop the bleeding. Post-operative complications were scarce. Conclusion:This study reflects on the need for a local multidisciplinary protocol to help expedite the current high-quality healthcare delivered by rural general surgeons in managing patients with UGIB. Implementing risk assessment scores would shorten the time to endoscopy in the initial assessment Guidelines would optimize resuscitation ensuring appropriate replacement, medication administration, anticoagulation reversal, and preventing unnecessary therapy. Despite these nuisances, the time to endoscopy, endoscopic intervention, and patient outcomes were largely in line with international quality assurance and safety targets.

Background The provision of high‐quality healthcare in rural Australian hospitals has necessitated general surgeons to take up the challenge and expand their expertise to advanced endoscopy techniques including endoscopic retrograde cholangiopancreatography (ERCP). This study examines the utility of ERCP in a regional setting especially in decreasing patient transfers and associated costs while achieving exceptional safety by measuring key indicators of safety and efficacy. Methods A single‐centre retrospective cross‐sectional cohort review in a rural Queensland hospital of patients who underwent ERCP (emergent and elective) from January 2019 until July 2022. Standardized international ERCP performance indicators were collected and compared to benchmark literature values including the rate of cannulation, stone extraction, successful stent placement, and post‐ERCP pancreatitis. Results The majority of the ERCP performance indicator benchmarks were met. 100% of patients had an appropriate indication for the procedure and consent. 98.95% successful CBD cannulation with only 14.14% requiring multiple attempts. 92.22% successful stone retrieval with 100% stent placement, well above guideline targets. The post‐procedural complication rate was 6.81% (2.09% pancreatitis; 1.05% pancreatitis; 1.05% duodenal perforation). Antibiotic prophylaxis adherence was identified to require improvement (12.57%). Conclusion High‐quality ERCP procedures can be performed in a regional hospital by general surgeons in a safe and cost‐effective manner, significantly decreasing the costs associated with patient transfer. This study reflects strong evidence for consistently achieving international ERCP performance benchmarks and the provision of high‐quality healthcare by a regional hospital and provides a strong argument for increasing access to ERCP in rural and remote hospitals.