We present the largest reported Australian series on partial nephrectomy, confirming that a robotic-assisted approach is equivalent to OPN, with reduced complications, EBL, length of hospital stays and fewer positive margins, even when resecting more complex tumours.

Adenocarcinoma of the cervix is often presumed to be primary at time of diagnosis, as metastatic disease is an unusual occurrence. Less than 10% of female reproductive tract cancers occur from extra-genital sites with only 3.4% affecting the cervix. 1 This is largely secondary to the fibrous tissue that constitutes the cervix, its relative small mass, limited blood flow and that pelvic lymphatic vessels anatomically drain away from instead of towards the cervix. 2 There is limited literature pertaining to the incidence of metastatic patterns in colorectal cancer including the activity of such metastasis during the disease course. Colorectal cancers typically spread via the vasculature through the mesentery. 3 Most common metastatic sites are the liver, followed by the lung. 3-5 This case demonstrates a rare case of cervical metastasis of a rectosigmoid adenocarcinoma. To our knowledge, this case is particularly unique as the patient's diagnosis was made after being considered disease free after 5 years of regular surveillance. Furthermore, the patient underwent successful chemoradiotherapy and R0 resection of the tumour which has not been described by alternate studies. According to the literature available, it appears that the majority of patients diagnosed with cervical metastasis have passed away within months after diagnosis, indicating these tumours are highly aggressive and associated with a poor prognosis. Our case highlights a rare pathway of metastasis in colorectal cancer while also demonstrating an unusually long time between her primary and secondary malignancy. As physicians and surgeons we should be mindful of the potential unusual pattern of this common malignancy.

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OBJECTIVES:To estimate the costs of management of children with structuralmetabolic epilepsy and to determine the cost-driving factors in the selected population. METHODS: This was a retrospective annual prevalence-based study that included patients who attended a paediatric neurology clinic in a tertiary referral centre in Malaysia. The total costs of epilepsy management were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardised for the year 2010. RESULTS: The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalisation and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the annual cost of epilepsy management. Similarly, child development and seizure type were also not associated with the cost of management. On the other hand, children who received polytherapy treatment, therapeutic drug monitoring, or adjuvant therapy with new antiepileptic drugs represented high-cost groups of patients. Moreover, the total annual cost of epilepsy management positively correlated with seizure frequency. CONCLUSIONS: This investigation was the first cost analysis study of epilepsy in Malaysia. The total annual cost of management for 120 patients with structural-metabolic epilepsy was RM 202,816 (i.e., RM 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management.