Background: Patients undergoing cancer treatment incur significant out-of-pocket costs attributed to both medical and non-medical expenditure. We quantified out-of-pocket costs for patients receiving surgical treatment for oesophageal cancer, and their financial toxicity. Methods: Patients who had undergone oesophagectomy for cancer completed an out-of-pocket questionnaire which determined medical costs, non-medical costs and carer costs. Financial toxicity was assessed using the validated Comprehensive Score for Financial Toxicity questionnaire. Out-of-pocket costs and financial toxicity were summarised using medians with bootstrapped 95% confidence intervals. Results: Seventy individuals completed the survey (43.3% response rate). The majority were male (85.7%), aged 60-79 (76.5%), and 0-5 years post-cancer diagnosis (55.7%). Median out-of-pocket expenditure was $1,352 and was mainly attributed to wage loss (64.7%), followed by carer cost (23.7%). Out-of-pocket costs were higher for younger age groups (40-59yrs) compared to those aged 60-79yrs (p=0.003). There was no statistically significant difference in out-of-pocket costs between public vs. privately insured patients. Median out-of-pocket costs trended higher for rural ($1,696) vs. urban located patients ($1,235), but this was not statistically significantly different (p = 0.140). The median financial toxicity score was 23.5 (95%CI: 21.0-27.5), indicating moderate financial toxicity. Financial toxicity did not differ significantly by age, gender, country of birth, education, or location. A lower income percentile was associated with greater financial toxicity (ρ = –0.30, p = 0.012). Conclusion: Patients facing oesophagectomy for cancer incur many out-of-pocket costs, mostly due to wage loss from time spent away from work for both patients and carers. Younger patients and those with lower income face proportionately greater financial burdens, highlighting a need for targeted support to reduce financial stress.

Purpose/Introduction: The failure to rescue (FTR) rate, defined as the mortality rate following major postoperative complication, is an important marker of the quality of surgical care. This paper examines the multifactorial contributors to FTR following pancreaticoduodenectomy, with an emphasis on identifying perioperative and institutional factors that influence patient outcomes. Methodology: A systematic review was performed in accordance with the PRISMA guidelines. A search was conducted of the Pubmed, Embase, Medline and Cochrane Library databases. Two authors independently reviewed the articles and extracted data for analysis. Results: A total of 10 studies were included for review, with a total of 60158 pancreaticoduodenectomy cases. The FTR rate ranged from 6.9% to 33%. Multiple studies identified advanced age, obesity, pre-existing renal disease and elevated American Society of Anaesthesiologist (ASA) scores to be associated with higher rates of FTR. Patients undergoing re-laparotomy had higher failure to rescue rates but there were mixed results for factors leading to this such as post-operative pancreatic fistulas. Disease-specific features, including pancreatic texture and duct size, were not associated with FTR across studies. Conclusion: FTR is driven less by the occurrence of certain technical or disease-related factors and more by patient vulnerability and the interventions once complications arise.

Purpose Survivors of esophagectomy often experience delayed gastric conduit emptying, dumping, and swallowing dysfunction, which significantly impairs quality of life. Most existing studies utilize generic or cancer-specific patient-reported outcome measures (PROMs) that do not adequately capture pyloric and conduit-specific dysfunctions. Symptom assessment tools such as the Gastroparesis Cardinal Symptom Index (GCSI) have been validated in native stomachs, not in gastric conduits, and their domain structure and clinical cut points remain unevaluated in post-esophagectomy populations. As a result, reported dumping prevalence varies widely (0–78%), reflecting inconsistent definitions and the lack of standardized, conduit-specific symptom assessment. Methodology This observational study enrolls disease-free adults between 6 and 12 months following esophagectomy with gastric conduit reconstruction. Participants complete a questionnaire evaluating: (1) GCSI-derived stomach symptoms; (2) early and late dumping symptoms; (3) dysphagia, reflux, and regurgitation; and (4) functional and nutritional impact. Clinical covariates include diabetes, opioid use, and time elapsed since surgery. The primary outcome is an externally anchored composite endpoint, defined by the need for pyloric or endoscopic intervention. Results It is hypothesized that symptom clusters dominated by fullness and early satiety will more effectively identify clinically meaningful functional morbidity than nausea-predominant GCSI domains. A straightforward PROM rule that combines elevated stomach symptom scores with multiple dumping features is anticipated to identify a high-risk subgroup with increased rates of malnutrition, intervention, or significant endoscopic findings, independent of diabetes and opioid use. Conclusion This study addresses a key methodological gap in post-esophagectomy PROM research by directly evaluating whether symptom questions adapted from native stomach and oncologic tools are appropriate for gastric conduit patients.

Abstract Chronic microleak following laparoscopic sleeve gastrectomy (LSG) represents a complex and morbid complication that can persist despite prolonged conservative and endoscopic management. Ongoing leakage is associated with sepsis risk, malnutrition, prolonged hospitalisation, and reduced quality of life. Conversion to Roux-en-Y gastric bypass (RYGB) has been proposed as a definitive surgical strategy by diverting enteric flow away from the leak site. This study aimed to evaluate the clinical outcomes, safety, and effectiveness of conversion to RYGB for the management of chronic microleak following LSG. Methodology Study Design and Setting A retrospective observational study was conducted at a tertiary upper gastrointestinal and bariatric surgery centre. Patients managed between January 2016 and December 2024 were identified from a prospectively maintained bariatric database. Patient Selection Inclusion criteria comprised adult patients (≥18 years) with a diagnosis of chronic microleak following LSG, defined as a contained gastric leak persisting beyond six weeks despite non-operative management. Outcome Measures Primary outcome: •Successful resolution of the gastric microleak following conversion to RYGB Results A total of 34 patients met the inclusion criteria. The median interval from index sleeve gastrectomy to conversion surgery was 6.1 months (IQR 4.5–10.2). Primary Outcome •Complete leak resolution was achieved in 32 patients (94.1%) following conversion to RYGB. •Two patients required prolonged drainage but achieved eventual resolution without further operative intervention. Conclusion Conversion to Roux-en-Y gastric bypass is a safe and effective definitive treatment for chronic microleak following laparoscopic sleeve gastrectomy when conservative and endoscopic strategies fail. The procedure reliably achieves leak resolution by excluding the leak site and diverting gastric contents, with acceptable morbidity and favourable nutritional outcomes.

Purpose: Anastomotic leak (AL) following oesophagectomy results in major patient morbidity and increased resource utilisation. While multimodality therapy improves survival, treatment-related toxicity may increase the risk of perioperative complications. Identifying modifiable risk factors for AL is therefore critical to reducing postoperative morbidity. We examined risk factors for AL and quantified its clinical impact in a high-volume Australian centre. Methodology: Patients undergoing curative-intent oesophagectomy with gastric conduit reconstruction for oesophageal or gastro-oesophageal junction cancer between 1993 and 2022 were identified from a prospectively maintained database. AL was defined using Esophagectomy Complications Consensus Group criteria. Risk factors were assessed using univariate and multivariate logistic regression. Results: Among 1,219 patients, AL occurred in 11% (131/1219). Patients who developed AL experienced substantially greater morbidity, with a longer median hospital stay (24 vs 13 days, p<0.01) and higher reoperation rates (16.8% vs 5.8%, p<0.01). On univariate analysis, male sex, preoperative weight loss >20%, clinical nodal stage cN2, and higher radiotherapy dose were associated with AL. Compared with 35 Gy, radiotherapy doses of 41.4 Gy (OR 2.8, 95% CI 1.25–6.48) and 45 Gy (OR 3.1, 95% CI 1.23–7.99) were associated with an increased risk of AL. On multivariate analysis, preoperative weight loss >20% remained independently associated with AL (OR 3.7, 95% CI 1.63–7.92). Conclusion: Anastomotic leak is associated with significant postoperative morbidity following oesophagectomy. Severe preoperative weight loss is an independent and potentially modifiable risk factor for AL. Targeted nutritional optimisation and careful radiotherapy planning may reduce anastomotic complications and their downstream clinical impact.

Purpose:G-POEM is an established intervention for refractory gastroparesis, yet clinical outcomes remain inconsistent, and optimal patient selection is challenging. Symptom severity, pyloric appearance, and response to intrapyloric botulinum toxin are commonly considered in clinical decision-making; a preoperative decision tool is lacking. The present study aimed to develop a preoperative risk score to predict clinical success following G-POEM in patients with post-surgical gastroparesis.Method: A retrospective analysis was performed of consecutive adult patients with refractory post-surgical gastroparesis who underwent G-POEM between 2018 and 2024. Clinical success was defined a priori as a reduction of at least 50% in GCSI total score at 6 to 12 months post-procedure, consistent with published G-POEM literature. A pragmatic, clinically weighted scoring system was developed. The resulting PREDICT-GPOEM score incorporates response to botulinum toxin, pyloric tightness, baseline GCSI severity, age over 60 years, and non-oesophagectomy aetiology. Result:24 patients underwent G-POEM, most frequently following hiatal hernia repair, oesophagectomy, or bariatric surgery. Clinical success was achieved in 75%. Response to botulinum toxin alone demonstrated a positive predictive value of approximately 74%. The PREDICT-GPOEM score stratified patients into low-, intermediate-, and high-risk groups, with clinical success rates of 40%, 65%, and 85%, respectively, demonstrating strong discriminatory ability. The score showed superior performance in non-oesophagectomy patients, consistent with established differences in symptom phenotype and conduit physiology. Conclusion:The PREDICT-GPOEM score effectively stratifies the probability of clinical success following G-POEM in post-surgical gastroparesis, demonstrating robust discrimination and clinically meaningful risk categorization.

PURPOSE: Anastomotic technique in minimally invasive esophagectomy (MIO) remains a critical determinant of postoperative outcomes. This study compares circular stapled end-to-side and linear stapled side-to-side intrathoracic anastomosis in MIO for oesophageal cancer, focusing on anastomotic leak rates, long-term stricture formation, as well as secondary outcomes including complications, recovery, and survival. METHODOLOGY: We conducted a retrospective cohort study of patients undergoing two-stage MIO with intrathoracic anastomosis for oesophageal cancer at a quaternary centre from January 2011 to December 2023. Exclusion criteria included age under 18, non-malignant pathology, or incomplete surgery. Patients were grouped by anastomotic technique (circular vs. linear stapled), demographic, clinical, and outcome data were analysed. RESULTS: Of 265 patients, 245 met inclusion criteria (161 circular, 84 linear). Baseline characteristics were comparable. The overall anastomotic leak rate was 11% higher in the circular group (13%) versus linear (7%), though more severe (grade 3) leaks were seen in the linear group. Stricture rates were similar between techniques (17.4% circular vs.16.6% linear). Median postoperative length of stay was 10 days in both groups and thirty-day readmission was slightly higher in the linear group (20% vs.17.4%), without statistical significance. Multivariate analysis identified active or recent smoking (within 3 months) as an independent predictor of stricture formation. CONCLUSION Both techniques resulted in similar stricture and recovery outcomes. Circular stapled anastomoses were associated with a higher overall leak rate, while linear stapled techniques had more severe leaks. Smoking status remains a significant modifiable risk factor for anastomotic stricture formation and should be addressed preoperatively.

Aim Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide, are increasingly prescribed for type 2 diabetes and weight management. A possible association with acute pancreatitis remains controversial. This study evaluated the incidence, presentation, and outcomes of acute pancreatitis in patients receiving semaglutide. Methods A retrospective observational study was performed at a tertiary referral centre between January 2020 and December 2024. Adult patients presenting with acute pancreatitis while actively receiving semaglutide were identified using hospital coding and pharmacy records. Diagnosis required revised Atlanta criteria. Patients with alternative dominant aetiologies, including gallstone disease with obstruction, alcohol misuse, hypertriglyceridaemia, or pancreatic malignancy, were excluded. Demographic data, semaglutide exposure, disease severity, management, and outcomes were analysed descriptively. Results Forty-one patients receiving semaglutide presented with acute pancreatitis; 26 met inclusion criteria. Mean age was 52.6 years, and 61.5% were female. Semaglutide was prescribed for type 2 diabetes in 65.4% and weight loss in 34.6%. Median duration of therapy prior to presentation was 5.2 months. Pancreatitis was mild in 76.9% and moderately severe in 23.1%; no severe or necrotising cases occurred. Median length of stay was 4 days. Two patients required intensive care admission, and no patients required surgical intervention. Semaglutide was ceased in all cases. No recurrent pancreatitis or mortality occurred during median follow-up of 9 months. Conclusion Acute pancreatitis temporally associated with semaglutide use was uncommon and predominantly mild, with favourable outcomes following drug cessation. Clinicians should consider medication-related pancreatitis in patients without traditional risk factors. Larger prospective studies are required to clarify causality and risk stratification.

Background: The global population is growing and living longer. We can see an increasing number of patients undergoing surgery at older ages, with increasing frailty and numbers of co-morbidities. The Geriatric Pre-Operative Service (GPS) provides a pre-operative geriatrician review for older adults due to undergo elective surgery. During the review, patients receive a Comprehensive Geriatric Assessment (CGA)—a structured evaluation of medical, cognitive, functional, and psychosocial factors—aimed to optimize perioperative management. This audit aimed to assess whether general surgery patients who were reviewed in the GPS had improved surgical outcomes compared with those receiving standard pre-operative care. Methods: A retrospective review was undertaken of 100 patients aged ≥65 years (≥60 for Aboriginal and Torres Strait Islander patients) who underwent elective general surgery (Upper GastroIntestinal, Colorectal & Hepatobiliary) between January 2024 and August 2025 under Inclusion criteria. Fifty patients attended the GPS and received CGA, while fifty underwent similar procedures without clinic review. Outcomes included hospital-acquired complications (HACs), length of stay (LOS), readmission rate and mortality. Results: The average length of stay was shorter for patients who were reviewed in the geriatric preoperative clinic (6.5 days) than those who were not (10.4 days). This difference was statistically significant with a p value= 0.0055. Patients seen in the GPS had approximately 22% lower odds of a hospital-acquired complication, but the difference is not statistically significant (p-value 0.079). The GPS cohort demonstrated reduced numbers of re-admissions to hospital, despite this there was no statistical difference between groups (P-value=0.186). Conclusion: Preoperative geriatrician review incorporating CGA was associated with a statistically significant reduction in length of hospital admission. These findings support the integration of geriatric assessment into preoperative care pathways.  

Background:Treatment for oesophageal cancer has a significant impact on health-related quality of life (HRQoL). Advances in treatment have resulted in improved survival rates, and the need to improve patient quality of life. This review summarises the evidence on the impact of various treatments on long-term quality of life in order to inform practice. Methods:A systematic literature search of MEDLINE (OVID), PubMed, CINAHL, Web of Science, Embase and the Cochrane library was performed to identify studies that evaluated quality of life at least 3 years following curative treatment. Data were extracted and compared narratively and in a meta-analysis, using odds ratio and mean differences with 95% confidence intervals. Results:A total of 11,618 studies were identified, and 31 studies were included in this review. Most of the studies were from Sweden (n=15) or China (n=5). HRQoL in most studies (90%) was assessed using EORTC QLQ-C30 in combination with the oesophageal cancer add-on, QLQ-OES18. Narrative synthesis revealed that most aspects of HRQoL recovered to preoperative levels at the 3-year assessment. Four studies applying QLQ-C30 were included in the meta-analysis: global quality of life had a mean difference of 3.08 (95% CI 0.2-5.96) and an effect size equaling 2 (p<0.04). Only emotional function, role function, and constipation had statistically non-significant differences between cancer patients and healthy individuals (p > 0.05). Conclusions: Overall, the quality of life for oesophageal cancer survivors should be a key focus for clinicians given its association with treatment outcomes and overall survival. There was evidence that some aspects of HRQoL recovered by 3-years but some impacts were longer lasting.