Accurate staging of esophageal cancer is important when determining which patients will potentially benefit from curative surgery. The aim of this study was to evaluate the incremental effect of 2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) when used in addition to standard staging modalities. Patients referred to two surgeons in an Australian metropolitan teaching hospital with esophageal or esophago-gastric junction malignancy between May 2002 and December 2006 were included. Patients who had undergone prereferral treatment with chemotherapy or radiotherapy were excluded. Patients undergoing resection for gastrointestinal stromal tumors or high-grade dysplasia within Barrett's esophagus were also excluded. Clinical and non-clinical data were recorded prospectively. Pretreatment staging included routine CT scan and selective endoscopic ultrasound (EUS). FDG-PET was performed in patients judged to have curable disease on CT scanning and EUS. From a total of 130 eligible patients, 76 were judged to have curable disease on the basis of CT and EUS findings. Of these 76 patients, 19 (25%) were excluded from surgery due to additional information obtained from FDG-PET. The addition of FDG-PET to routine preoperative staging resulted in the exclusion from surgery of 19 (25%) patients who prior to the introduction of FDG-PET would have undergone attempted resection. FDG-PET should be performed in all patients under consideration for esophagogastric resection in order to avoid resection in patients with disseminated disease.

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Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information

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