Browsing by Author "Warrier, Satish K."

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    Beyond transanal total mesorectal excision: short-term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision
    (2021) Larach, Jose Tomas; Rajkomar, Amrish K. S.; Smart, Philip J.; McCormick, Jacob J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim The aim of this work was to define the role of transanal total mesorectal excision (taTME) in locally advanced rectal cancer (LARC) requiring resection beyond the mesorectal plane.
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    Fellowship training in robotic colorectal surgery within the current hospital setting: an achievable goal?
    (2021) Waters, Peadar S.; Flynn, Julie; Larach, José T.; Diharah, Fernando; Peacock, Oliver; Foster, Jake D.; Flood, Michael; McCormick, Jacob J.; Warrier, Satish K.; Heriot, Alexander G.
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    Impact of the approach on conversion to open surgery during minimally invasive restorative total mesorectal excision for rectal cancer
    (2023) Larach, Jose Tomas; Kong, Joseph; Flynn, Julie; Wright, Timothy; Mohan, Helen; Waters, Peadar S.; McCormick, Jacob J.; Warrier, Satish K.; Heriot, Alexander G.
    BackgroundThe aim of this study is to explore the impact of the approach on conversion in patients undergoing minimally invasive restorative total mesorectal excision within a single unit.MethodsA retrospective cohort study was conducted. Patients with rectal cancer undergoing minimally invasive restorative total mesorectal excision between January 2006 and June 2020 were included. Subjects were classified according to the presence or absence of conversion. Baseline variables and short-term outcomes were compared. Regression analyses were conducted to assess the relationship between the approach and conversion.ResultsDuring the study period, 318 patients underwent a restorative proctectomy. Of these, 240 met the inclusion criteria. Robotic and laparoscopic approaches were undertaken in 147 (61.3%) and 93 (38.8%) cases, respectively. A transanal approach was utilised in 62 (25.8%) cases (58.1% in combination with a robotic transabdominal approach). Conversion to open surgery occurred in 30 cases (12.5%). Conversion was associated with an increased overall complication rate (P = 0.003), surgical complications (P = 0.009), superficial surgical site infections (P = 0.02) and an increased length of hospital stay (P = 0.006). Robotic and transanal approaches were both associated with decreased conversion rates. The multiple logistic regression analysis, however, showed that only a transanal approach was independently associated with a lower risk of conversion (OR 0.147, 0.023-0.532; P = 0.01), whilst obesity was an independent risk factor for conversion (OR 4.388, 1.852-10.56; P < 0.00).ConclusionsA transanal component is associated with a reduced conversion rate in minimally invasive restorative total mesorectal excision, regardless of the transabdominal approach utilised. Larger studies will be required to confirm these findings and define which subgroup of patients could benefit from transanal component when a robotic approach is undertaken.
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    Robotic beyond total mesorectal excision surgery for primary and recurrent pelvic malignancy: Feasibility and short-term outcomes
    (2022) Tomas Larach, Jose; Flynn, Julie; Fernando, Diharah; Mohan, Helen; Rajkomar, Amrish; Waters, Peadar S.; Kong, Joseph; McCormick, Jacob J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim To explore the feasibility and safety of robotic beyond total mesorectal excision (TME) surgery for primary and recurrent pelvic malignancy. Methods Patients undergoing robotic beyond TME resections for primary or recurrent pelvic malignancy between July 2015 and July 2021 in a public quaternary and a private tertiary centre were included. Demographic and clinical data were recorded and outcomes analysed. Results Twenty-four patients (50% males) were included, with a median age of 58 (45-70.8) years, and a BMI of 26 (24.3-28.1) kg/m(2). Indication for surgery was rectal adenocarcinoma in nineteen, leiomyosarcoma in two, anal squamous cell carcinoma in one and combined rectal and prostatic adenocarcinoma in two patients. All patients required resection of at least one adjacent pelvic organ including genitourinary structures (n = 23), internal iliac vessels (n = 3) and/or bone (n = 2). Eleven patients had a restorative procedure. Of the 13 nonrestorative cases, nine needed perineal reconstruction with a flap. There was one conversion due to bleeding. The mean operating time was 370 (285-424) min, and the median blood loss was 400 (200-2,000) ml. The median length of stay was 16 (9.3-23.8) days. Fourteen patients (58.3%) had postoperative complications; eight of them (33.3%) were Clavien-Dindo III or more complication. Twenty-three (95.8%) patients had an R0 resection. During a median follow-up of 10 (7-23.5) months, five patients (20.8%) had systemic recurrences. No local recurrences were identified during the study period. Conclusion Implementation of robotic beyond TME surgery for primary and recurrent pelvic malignancy is feasible within a highly specialised setting.
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    Robotic colorectal surgery in Australia: evolution over a decade
    (2021) Larach, Jose Tomas; Flynn, Julie; Kong, Joseph; Waters, Peadar S.; McCormick, Jacob J.; Murphy, Declan; Stevenson, Andrew; Warrier, Satish K.; Heriot, Alexander G.
    Background: Despite reports of increasing adoption of robotics in colorectal surgery worldwide, data regarding its uptake in Australasia are lacking. This study examines the trends of robotic colorectal surgery in Australia during the last 10 years.
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    Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes
    (2022) Larach, Jose Tomas; Flynn, Julie; Wright, Timothy; Rajkomar, Amrish K. S.; McCormick, Jacob J.; Kong, Joseph; Smart, Philip J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer. Methods Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. Results Fifty-one patients were included; 25 (49%) of them had an RCME. The groups were evenly distributed in terms of demographic characteristics and tumour location. Operative time was similar between both groups, and no patients required conversion to open surgery. There were no differences in overall complications (16% in RCME vs. 26.9% in RRC; p = 0.499) or their profile between groups. There were no anastomotic leaks recorded, and the reoperation rates were similar (0% for RCME versus 3.8% for RRC; p = 1). In addition, the median length of hospital stay was similar in between the RCME and the RRC groups (4 [4-6] days versus 5 [3-8.5] days, respectively; p = 0.891). Whilst there were no differences in the TNM staging, the mean number of lymph nodes harvested with RCME was 37.7 (+/- 12.9) compared to 21.8 (+/- 7.5) with RCC (p < 0.001). Conclusion In our series, RCME was associated with a higher lymph node harvest and a similar morbidity profile compared to RCC. Further studies are required to validate these results and provide long-term oncologic outcomes.
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    Robotic pelvic side-wall dissection and en-bloc excision for locally advanced and recurrent rectal cancer: outcomes on feasibility and safety
    (2022) Lokuhetty, Naradha; Tomas Larach, Jose; Rajkomar, Amrish K. S.; Mohan, Helen; Waters, Peadar S.; Heriot, Alexander G.; Warrier, Satish K.
    Background: Global differences exist in managing lateral pelvic nodes in rectal cancer. Recent studies demonstrate improved local recurrence rates in patients undergoing lateral pelvic lymph node dissections (LPND) in addition to total mesorectal excision (TME) for advanced lower rectal cancer. This study aims to report on the safety and feasibility of the robotic approach in patients undergoing pelvic sidewall lymph node dissection or en-bloc sidewall resection for advanced lower rectal cancer.
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    Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes
    (2023) Larach, Jose Tomas; Flynn, Julie; Tew, Michelle; Fernando, Diharah; Apte, Sameer; Mohan, Helen; Kong, Joseph; McCormick, Jacob J.; Warrier, Satish K.; Heriot, Alexander G.
    BackgroundAlthough several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform.MethodsConsecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs.ResultsDuring the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 +/- 83.4 versus 243 +/- 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 +/- 8235 versus A$15,525 +/- 6382; P < 0.001) and overall costs (A$34,350 +/- 14,770 versus A$26,083 +/- 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA >= 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1).ConclusionRobotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.