Innominate artery injuries have high rates of morbidity and mortality. A vascular surgical approach with pre-operative angiography, when possible and careful surgical planning by a dedicated team promotes better surgical results. Endovascular and hybrid procedures can become the method of choice when treating stable patients.

The aim of an oesophagectomy for cancer is long-term cure because of the availability of effective non-surgical ways of palliating dysphagia.1 Long-term survival is affected negatively by the N, T and R0 stages. 2 The oncological principle underlying curative resection of solid tumours is complete local clearance. Surprisingly little is published about the local resection of oesophageal cancers yet there is much debate about the optimal surgical approach to the oesophagus, ie whether it should be done via the right chest, left chest, transhiatal or laparoscopic route. 3,4Altorki and Skinner described good long-term survival after an en bloc oesophagectomy in which he combined a radical local resection with a 2-3 field block dissection of lymph nodes.5 By focusing on the local resection of the primary tumour rather than the lymphadenectomy in rectal cancer, total mesorectal resection of the rectum has been shown by studies replicated across the world to be associated with superior local recurrence rates and long-term survival compared with other surgical techniques. 6Furthermore, the pathological processing of resected rectums with external inking and slicing the specimens transversely for assessment on large histopathology slides have helped both in setting standards for histopathology reporting and also in assessing the quality of surgical resection. An adequately performed total mesorectal resection of the rectum (judged both surgically and histopathologically) is now considered the optimal operation for patients with rectal cancer. 7 We adopted the principles of rectal cancer surgery (ie standard surgical dissection techniques of the primary tumour as well as standard pathological processing and reporting) and assessed the feasibility of applying them to oesophagogastric junction (OGJ) cancer. Little is published about the local resection of oesophageal cancers. We adopted the principles of rectal cancer surgery, ie standard surgical dissection techniques as well as standard pathological processing and reporting, and assessed the feasibility of applying them to oesophagogastric junction (OGJ) cancer. METHODS Over a two-year period consecutive patients with invasive cancers of the OGJ were studied. Following staging and neoadjuvant chemotherapy (NAC), a standard dissection defined as a total adventitial resection of the cardia (TARC) was performed. Standard histopathological processing involved external inking, photographing, transverse slicing and mounting of cut samples on megablocks. Hospital morbidity and mortality as well as survival at five years' follow-up were assessed. RESULTS Forty consecutive patients had a TARC for OGJ carcinoma. Of these, 32 were offered NAC. Introducing TARC did not result in increased morbidity or mortality. Twenty-seven patients (68%) had an R0 resection that was directly related to the tumour stage and significantly related to a response to chemotherapy. Sixteen patients (42%) were alive five years after their TARC operation. CONCLUSIONS Although the adventitia of the OGJ is n...

Background: In South Africa, 42.0% of adult females and 13.5% of adult males are classified as obese, the highest recorded numbers in Sub-Saharan Africa. Metabolic surgery has been proven to be a safe and effective treatment, yet due to demand on government resources has only been performed to a limited extent in public hospitals. The aim of this study was to describe the safety and efficacy of performing metabolic surgery at a single academic hospital in South Africa. Methods: This was a single centre retrospective review of 57 metabolic surgery procedures performed from October 2011 to September 2017 at Tygerberg Hospital, Cape Town, South Africa. The primary outcome was safety including mortality and adverse events. Secondary outcomes included effect of surgery on weight and diabetes resolution. Results: A total of 57 patients underwent laparoscopic metabolic surgery, of which 44 (83.0%) were female with a mean age (standard deviation) of 42.8 (8.0) years. Fifty-six patients (98%) underwent Roux-and-Y gastric bypass and one (2%) had a sleeve gastrectomy performed. There were no mortalities and overall morbidity was 14.0%, with 3 (5.3%) classified as major and 5 (8.8%) as minor. The follow-up rate at 1 year was 100%. Mean preoperative body mass index (BMI) was 58.8 kg/m2, and comorbidities included hypertension (59.6%), Type 2 Diabetes (42.1%), and dyslipidaemia (36.8%). There were no conversions to open surgery and at one year the mean (95% confidence interval) percentage excess body mass index loss was 50.4% (44.0-56.8%). Conclusions: Metabolic surgery can be performed safely in the public sector in South Africa, with short-term safety and efficacy outcomes comparable to international reports. Larger scale studies are needed to determine long-term outcomes and cost-effectiveness.