Neoadjuvant therapy (NAT) for oesophageal cancer may reduce cardiopulmonary function, assessed by cardiopulmonary exercise testing (CPEX). Impaired cardiopulmonary function is associated with mortality following esophagectomy. We sought to assess the impact of NAT on cardiopulmonary function using CPEX and assessing the clinical relevance of any change in particular if changes were associated with post-operative morbidity. This was a prospective, cohort study of 40 patients in whom CPEX was performed before and after NAT. Thirty-eight patients underwent surgery and follow-up with perioperative outcomes measured. The primary variables derived from CPEX were the anaerobic threshold (AT) and peak oxygen uptake (V˙Opeak). There were significant reductions in the AT (pre-NAT: 12.4 ± 3.0 vs. post-NAT 10.6 ± 2.0 mL kg.min; p = 0.001). This reduction was also evident for V˙Opeak (pre-NAT: 16.6 ± 3.6 vs. post-NAT 14.9 ± 3.7 mL kg.min; p = 0.004). The relative reduction in V˙Opeak was greater in chemotherapy patients who developed any peri-operative morbidity (p = 0.04). For patients who underwent chemoradiotherapy, there was a significantly greater relative reduction in AT (p = 0.03) for those who encountered a respiratory complication. Cardiopulmonary function significantly declined as a result of NAT prior to oesophagectomy. The reduction in AT and V˙Opeak was similar in both the chemotherapy and chemoradiotherapy groups.
Preoperative dehydration may be associated with postoperative acute kidney injury. Avoiding dehydration in the preoperative period may be advisable, and adherence to international evidence-based guidelines on preoperative fasting is recommended.
Background
Skin cancer is a relatively common cancer in Australia, with early, simple treatment conferring a high likelihood of cure. Early diagnosis and treatment are important to reduce morbidity and mortality. A see-and-treat clinic seeks to offer earlier diagnosis and treatment as compared with a traditional model of care. The aim was to implement this model using pre-existing infrastructure with a hypothesis that this service will reduce wait times with reduced costs and high levels of patient satisfaction
Methods
Referrals were screened and those suitable underwent consultation with a Plastic and Reconstructive Surgeon and same-day operative management with their choice of anaesthesia. Patients were reviewed 1 week and 4 weeks postoperatively.
Results
206 patients had 286 skin lesions removed over 23 operating lists. Over 75% of excisions were on the face. Local anaesthetic with sedation was the most popular anaesthetic technique There were 22 complications and the incomplete excision rate was 4.2%. Average wait time for SLAM-suitable patients reduced by 76%, and category 1 outpatient waitlists were reduced by 100%. An estimated gross saving of $1,339 per patient was calculated. A survey of patients post-operatively showed all patients would recommend this model.
Conclusion
This see-and-treat model was shown to reduce wait times and cost, along with high levels of patient satisfaction. It was also easily implemented using pre-existing infrastructure. It is a service that continues to be offered and expanded, with ongoing patient satisfaction.
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