Papers by Nicholas Lutton
International Journal of Colorectal Disease, Aug 29, 2020
Purpose Performing a right hemicolectomy (RH) is a core technical competency for general surgical... more Purpose Performing a right hemicolectomy (RH) is a core technical competency for general surgical trainees. There is a concern that anastomotic leaks occur more frequently when patients are operated on by trainees rather than by surgeons. This study aims to analyse the quality of care outcomes after RH, stratified by the experience level of the operator. Methods Patients were retrospectively recruited from the Bi-National Colorectal Cancer Audit (BCCA) Registry, from 2007 to 2018. All patients who underwent a RH for colorectal cancer were eligible. The primary outcome measure was anastomotic leak rate. Results A total of 6548 eligible right hemicolectomies were identified, with 74% being performed by consultants, 12% by fellows, and 14% by surgical trainees. The overall incidence of an anastomotic leak was 2.1%, with the highest rate of 3.7% noted among supervised registrars. Positive resection margin rate was the highest among unsupervised trainees at 10.5%, as compared with 4.3% among consultants. Anastomotic leak, anastomotic bleeding, prolonged ileus, and pneumonia occurred significantly less frequently with consultant surgeons, as compared with trainees. Independent risk factors for anastomotic leak were urgent surgery, extended right hemicolectomy, conversion to open surgery, and a lower level of operator seniority. Two independent risk factors were identified for inpatient mortality-a high ASA score (III and above) and urgent surgery. Conclusion RH is a common operative procedure in general surgical training. Data from this study may assist with the structuring of surgical training programmes, aimed at maximising both patient safety and trainee professional development and education.
International Surgery, 2015
Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a ra... more Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a radical but effective treatment option for select peritoneal malignancies. We sought to determine our early experience with this method for peritoneal carcinomatosis secondary to mucinous adenocarcinomas of appendiceal origin. As such, we performed a retrospective clinical study of 30 consecutive patients undergoing CRS with planned HIPEC at the Princess Alexandra Hospital, between June 2009 to December 2012, with mucinous adenocarcinomas of the appendix. CRS was performed in 30 patients, 13 received HIPEC intraoperatively and 17 received early postoperative intra-peritoneal chemotherapy (EPIC) in addition. Mean age was 52.3 years and median hospital stay was 26 days (range 12-190 days). Peritoneal cancer index scores were 0-10 in 6.7% of patients, 11-20 in 20% of patients and .20 in 73.3% of patients. Complete cytoreduction was achieved overall in 21 patients. In total, 106 complications were observed in 28 patients. Ten were grade 3-A, five were grade 3-B and one grade-5 secondary to a fatal PE on day 97. In patients who received HIPEC, there was no difference in disease-free survival (P ¼ 0.098) or overall survival (P ¼ 0.645) between those who received EPIC versus those who did not. This study demonstrates that satisfactory outcomes with regards to morbidity and survival can be achieved with CRS and HIPEC, at a single-centre institution with growing expertise in the technique. Our results are comparable with outcomes previously described in the international literature.
PLOS ONE, Dec 7, 2015
To investigate the relationship between displacement of pelvic floor landmarks observed with tran... more To investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements.
Springer eBooks, Mar 5, 2007
ABSTRACT
Anz Journal of Surgery, Feb 12, 2019
Background: Acute appendicitis is the most common non-obstetric surgical presentation during preg... more Background: Acute appendicitis is the most common non-obstetric surgical presentation during pregnancy. There were concerns that laparoscopic appendicectomy increases the risk of foetal loss compared to an open approach. Therefore, with recent advances in perioperative care, it is likely the risk has changed. Here, we performed an updated meta-analysis assessing the safety of laparoscopic appendicectomy in pregnant women. Methods: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was undertaken between 2000 and 2017 on Ovid Medline and Embase. The primary outcome measures were foetal loss and preterm delivery, whereas secondary outcome measures were operative time and hospital length of stay. A random-effect model was performed to pool odds ratio (OR) and standardized mean difference (SMD). Results: Seventeen observational studies were included, with 1886 patients in the laparoscopic and 4261 patients in the open group. Comparing laparoscopic versus open appendicectomy, there were 54 (5.96%) and 136 (3.73%) foetal losses, respectively. However, preterm delivery was much higher in the open approach (8.99%) compared to laparoscopic approach (2.84%). Pooled OR for foetal loss was 1.84 (95% confidence interval (CI) 1.31-2.58, P < 0.001), whereas OR for preterm delivery was 0.39 (95% CI 0.27-0.55, P < 0.001). There was no significant difference between both approaches for operative time (SMD −0.07; 95% CI −0.43 to 0.30, P = 0.71) or hospital length of stay (SMD −0.34; 95% CI −0.83 to 0.16, P = 0.18). Conclusion: In a pooled analysis of level III evidence, laparoscopic appendicectomy posed a higher risk of foetal loss but lower risk of preterm delivery. Caution and informed consent are crucial when offering a laparoscopic approach.
Colorectal Disease, Jul 12, 2021
This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as
Physiotherapy, May 1, 2015
Anz Journal of Surgery, May 1, 2009
Purpose: Sacral nerve stimulation (SNS) is a promising new modality to treat faecal incontinenc... more Purpose: Sacral nerve stimulation (SNS) is a promising new modality to treat faecal incontinence. This study was designed to examine patient satisfaction with the procedure and relate this to changes in quality of life (QoL) and incontinence scores.Methodology: Twenty‐eight patients underwent insertion of a permanent stimulator after temporary stimulation had achieved a good result. Faecal incontinence QoL data, incontinence scores (scale 0–24) and baseline anorectal physiology measurements were recorded prospectively in a database, together with a postoperative survey and repeat physiological investigations.Results: Twenty‐four patients (86%) completed the survey. The median age of patients at the time of SNS insertion was 62 yrs (range 47–83) and median follow‐up was 10 months (2–50 m). The mean St Mark's incontinence scores were 16.9 pre‐operatively and 10.6 post‐operatively (p &lt; 0.001). Faecal incontinence quality of life (FIQL) measurements showed statistically significant improvements across all domains (lifestyle p = 0.02, coping p &lt; 0.01, depression p = 0.01 and embarrassment p &lt; 0.01). Mean patient satisfaction was 6.8 (visual analogue scale of 0–10). This score showed statistically significant correlations with both incontinence scores and three out of four FIQL domains. No correlation was seen with duration of treatment and patient satisfaction.Conclusion: SNS is a valid procedure for faecal incontinence as demonstrated by significant improvements in incontinence scores, FIQL measurements and these improvements are closely correlated to patient satisfaction with the procedure.
Clinical Case Reports, Aug 21, 2019
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
<p>Mean asymptote (“<i>a</i>”), curvature (“<i>b</i>”) and R<sup... more <p>Mean asymptote (“<i>a</i>”), curvature (“<i>b</i>”) and R<sup>2</sup> values for each comparison of landmark displacement and EMG amplitude for maximal voluntary contraction.</p
<p>Mean asymptote (“<i>a</i>”), curvature (“<i>b</i>”) and R<sup... more <p>Mean asymptote (“<i>a</i>”), curvature (“<i>b</i>”) and R<sup>2</sup> values for each comparison of landmark displacement and EMG amplitude for sub-maximal contraction.</p
<p>Data normalised to peak are shown (left) in addition to the corresponding raw data (righ... more <p>Data normalised to peak are shown (left) in addition to the corresponding raw data (right).</p
Anz Journal of Surgery, Aug 28, 2020
BackgroundThe incidence of colorectal cancer (CRC) in younger adults (&lt;50 years old) is ri... more BackgroundThe incidence of colorectal cancer (CRC) in younger adults (&lt;50 years old) is rising worldwide, at a rate of 1% per annum since mid‐1980s. The clinical concern is that younger adults may have more advanced disease leading to poorer prognosis compared to their older cohort due to lack of screening. Therefore, the aim of this study is to assess the incidence and short‐term outcomes of colorectal cancer in younger adults.MethodsThis is a retrospective study from a prospectively maintained bi‐national database from 2007 to 2018.ResultsThere were 1540 younger adults diagnosed with CRC, with a rise from 5.8% in 2007 to 8.4% in 2018. Majority had lower American Society of Anaesthesiologists (ASA) scores (89%), rectal cancers (46.1%) and higher tumour stage (65.4%). As a consequence, they were likely to have higher circumferential resection margin positivity (6%, P = 0.02) and to receive adjuvant chemotherapy (57.1%, P &lt; 0.001) compared to their older cohort. Multivariate analysis showed disadvantaged socioeconomic status (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.37–7.94, P &lt; 0.001) and increasing tumour stage (OR 14.9, 95% CI 1.89–116.9, P &lt; 0.001) were independent predictors for circumferential resection margin positivity whereas being female (OR 0.71, 95% CI 0.53–0.95, P = 0.02), higher ASA score (OR 175.3, 95% CI 26.7–1035.5, P &lt; 0.001), urgent surgery (OR 2.75, 95% CI 1.84–4.11, P &lt; 0.001) and anastomotic leak (OR 5.02, 95% CI 3.32–7.58, P &lt; 0.001) were predictors of inpatient mortality.ConclusionThere is a steady rise in the incidence of colorectal cancer in younger adults. Both physicians and younger adults should be aware of the potential risk of colorectal cancer (CRC) and appropriate investigations performed so not to delay the diagnosis.
<p>Representative transperineal ultrasound images recorded in the (A) relaxed and (B) contr... more <p>Representative transperineal ultrasound images recorded in the (A) relaxed and (B) contracted states with pelvic structure borders and points of interest superimposed on the images. (C) Combined borders from the two images to indicate change in position. The circles indicate the points of interest used for displacement calculations, and the arrows indicate direction of displacement with voluntary contraction.</p
<p>Lines are generated using the mean R<sup>2</sup>, asymptote and curvature fo... more <p>Lines are generated using the mean R<sup>2</sup>, asymptote and curvature for the group. MU–mid-urethra, UVJ–urethra-vesical junction, ARJ–ano-rectal junction, BP–bulb of penis, SUS–striated urethral sphincter, PR–puborectalis, BC–bulbocavernosus.</p
<p>MU–mid-urethra, UVJ–urethra-vesical junction, ARJ–ano-rectal junction, BP–bulb of penis,... more <p>MU–mid-urethra, UVJ–urethra-vesical junction, ARJ–ano-rectal junction, BP–bulb of penis, SUS–striated urethral sphincter, PR–puborectalis, BC–bulbocavernosus.</p
Purpose To investigate the relationship between displacement of pelvic floor landmarks observed w... more Purpose To investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements. Materials and Methods Three healthy men participated in this study, which included ultrasound imaging of the mid-urethra, urethra-vesical junction, ano-rectal junction and bulb of the penis. Fine-wire electro-myography electrodes were inserted into the puborectalis and bulbocavernosus muscles and a transurethral catheter electrode recorded striated urethral sphincter electromyogra-phy. A nasogastric sensor recorded intra-abdominal pressure. Tasks included submaximal and maximal voluntary contractions, and Valsalva. The relationship between each of the parameters measured from ultrasound images and electromyography or intra-abdominal pressure amplitudes was described with nonlinear regression. Results
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Papers by Nicholas Lutton