Background: Malnutrition is associated with long-term complications such as functional decline and morbidity. However, there are no standardized local guidelines on nutritional care post-discharge. This study aims to evaluate the implementation of SUPREME-PLuS, a nurse-led quality improvement project which was developed to improve the hospital-to-home transition. It comprises checklists, patient education and post-discharge follow-up calls. Methodology: A single institution prospective cohort study was performed. All adult patients who undergone elective colorectal surgeries were included. Day surgeries and emergency surgeries were excluded. A mixed-methods approach was utilised to evaluate the implementation of SUPREME-PLuS in accordance with the RE-AIM framework. Qualitative analysis comprised interviews conducted in a semi-structured format. Subsequently, a thematic analysis was performed based on the Theoretical Domains Framework. Quantitative analysis was utilised to describe the baseline cohort characteristics and perform statistical analyses of pre- and post-intervention outcomes. Results: Among 101 patients with a mean age of 68.1 ± 10.4, there was a statistically significant increase in the nutritional assessment scores (p<0.05) and confidence in self-management scores (p<0.05). The median EQ-5D-5L scores was maintained pre-operatively, with a slight decrease after the implementation of SUPREME-PLuS (p=0.110). The 30-day readmission rate decreased (9.0% vs 6.9%, p=0.462). Readmissions attributed to malnutrition declined as well (3.6% vs 0%, p<0.05). The main barriers to the execution of SUPREME-PLuS were manpower limitations, insufficient training, and separate workflows leading to inconsistent implementation. Accordingly, regular knowledge reinforcements by the QI team helped to address such problems. Conclusion: SUPREME-PLuS is a cost-effective intervention which mitigates the risks of malnutrition and reduces readmission rates. Sustainability can be improved by leveraging technology to simplify operational workflows.

Background: Sexual dysfunction is a prevalent and distressing side effect of colorectal cancer treatment, particularly among early-onset colorectal cancer (EOCRC) patients. However, discussions around sexual health are often neglected, especially for women. This study aimed to investigate patterns of sexual health communication and to identify perceived barriers from both patient and provider perspectives. Methods: A retrospective survey was conducted involving 113 EOCRC survivors and 64 healthcare providers (surgeons, trainees, and nurse specialists) in Aotearoa New Zealand. Questionnaires assessed recall of sexual health discussions, perceived adequacy of information, communication preferences, and perceived barriers to raising sexual health concerns. Results: Only 30.3% of patients recalled receiving adequate information about sexual health impacts during treatment, and 21.6% during follow-up. Women were significantly less likely than men to report receiving information (p<0.001). Most patients preferred that healthcare providers initiate discussions, yet only 22.2% and 12.5% of providers reported routinely doing so during treatment and follow-up, respectively. Consultant surgeons were more likely to raise the topic than trainees (p<0.001). Key barriers included time constraints, concerns about offending patients, and the presence of family. Patients indicated a preference for receiving information via multiple modalities. Conclusions: Communication about sexual health in EOCRC care is inconsistent and frequently inadequate, particularly for women. Patients report a preference for clinicians to initiate discussions about sexual health, yet many providers cite limited confidence, training, or time as barriers. Enhanced clinician education, routine inclusion of sexual health in consultations, provision of both verbal and written information, use of pre-appointment questionnaires, and routinely asking family members to step out at the conclusion of consultations represent pragmatic, low-cost strategies to improve sexual health communication

Purpose Anterior resection (AR) is associated with postoperative bowel dysfunction, but long-term data on bowel, bladder and sexual function following AR versus right hemicolectomy (RH) are limited. This study compared long-term functional outcomes and health-related quality of life(HRQoL) between patients undergoing AR and RH using validated questionnaires. Methodology A prospective cohort study was conducted at a tertiary referral centre, including consecutive patients who underwent AR or RH for colorectal adenocarcinoma between 2015 and 2024. All patients alive and without a stoma completed a postal questionnaire in 2025. Bowel function was assessed using the Low Anterior Resection Syndrome(LARS), St Mark’s incontinence, Altomare obstructed defaecation syndrome(ODS) and Wexner constipation scores. Bladder function was evaluated using sex-specific ICIQ-MLUTS and ICIQ-FLUTS questionnaires. Generic and cancer-specific quality of life were assessed using SF-36v2, EORTC QLQ-C30, and QLQ-CR29. Outcomes were compared using univariate and age-adjusted analyses. Results A total of 206 patients were included(133 AR, 73 RH).The AR group was younger(70.8 vs 77.8 years, p<0.001); and included fewer men(63.9% vs 72.2%, p=0.016). AR patients reported worse bowel outcomes, including higher prevalence of major LARS(28.6% vs 11.0%, p=0.002), higher St Mark’s incontinence scores(p=0.002), and higher ODS scores p=0.006). Stool frequency and diarrhoea scores were worse following AR on EORTC QLQ-C30 and QLQ-CR29. Bladder function did not differ between groups. Female sexual function was lower following AR, while male sexual function was comparable. Overall HRQoL was similar, although RH patients reported greater bodily and abdominal pain. Conclusion AR is associated with greater long-term burden of bowel dysfunction and selected sexual function impairments compared with RH, despite similar HRQoL. This unique long-term comparison informs patient counselling and surgical decision-making.

Purpose As survival following colorectal cancer (CRC) surgery improves, long-term health-related quality of life (HRQoL) has emerged as a critical outcome of surgical care. However, survivorship data from regional Australia remain limited despite known disparities in access to multidisciplinary services. This study evaluated HRQoL after CRC surgery in a regional population and identified clinical and psychosocial determinants of poor outcomes, with a focus on modifiable targets for collaborative survivorship care. Methodology A cross-sectional study was conducted of patients who underwent CRC resection at a regional Australian hospital between 2015 and 2022. Participants completed validated patient-reported outcome measures assessing HRQoL, anxiety, depression, fear of cancer recurrence, social support, optimism, health literacy, and spiritual wellbeing. Demographic, disease, and operative data were collected via retrospective chart review. HRQoL scores were compared with Australian population norms, and associations with explanatory variables were analysed. Results Forty-seven patients participated. Compared with population norms, patients reported significantly worse HRQoL across multiple functional and symptom domains. Clinically significant anxiety and fear of cancer recurrence were common. Psychosocial factors demonstrated the strongest and most consistent associations with HRQoL, exceeding the influence of surgical approach, complications, tumour stage, or time since surgery. Conclusion Long-term HRQoL following CRC surgery in regional Australia is predominantly shaped by psychosocial distress rather than operative factors alone. These findings highlight a critical gap in current surgical care and support the integration of routine psychosocial screening and multidisciplinary, collaborative survivorship pathways within colorectal surgical services to improve outcomes for regional patients.

Purpose: Rubber band ligation (RBL) is the first-line non-operative procedure for internal haemorrhoidal disease. Pain is more common following RBL than alternative non-operative procedures, and there is currently no consensus around analgesic approach, with submucosal local anaesthetic injection (SLAI), pudendal nerve blocks (PNBs) and no locoregional anaesthesia used in practice. Evidence for SLAI use is limited and no studies have assessed the use of PNB in RBL. The aim of this study was to determine the relative effectiveness of SLAI and PNB in reducing pain following RBL. Methodology: A double-blinded randomised controlled trial was conducted across five hospitals. Patients undergoing RBL were randomised to receive SLAI (0.5% bupivacaine with adrenaline injected deep to the band), PNB (1% ropivacaine injected at the pudendal nerve using anatomic landmarks), or no locoregional anaesthesia (control). Primary outcomes were patient-reported pain scores on a 10-point Numeric Rating Scale at 30 minutes, 2 hours, 4 hours, 24 hours and 2 weeks following RBL. Secondary outcomes were post-procedural analgesia use, time-to-discharge, days until return to work, patient satisfaction and complications. Results: A total of 120 participants (42 control, 36 SLAI, 42 PNB) were included. Median pain scores in intervention groups were significantly lower than the control group at 30 minutes, 2 hours (SLAI) and 4 hours. Median pain scores (IQR) in control, SLAI and PNB groups, respectively, were: at 30 minutes, 4 (1-5), 0.5 (0-2.75) and 1.5 (0-4.25), p= 0.004; at 2 hours, 2 (0-4), 0 (0-2) and 0 (0-4), p=0.035; and at 4 hours, 1 (0-3), 0 (0-1) and 0 (0-2), p=0.005. At 24 hours and 2 weeks, median pain score in all groups was 0. There were no significant differences in secondary outcomes between treatment groups. Conclusion: Following RBL, SLAI and PNB reduce pain in the early post-operative period. There was no difference in the effectiveness of SLAI and PNB at any timepoint.

Purpose The use of robotic platforms for transanal resection (R-TAMIS) of rectal polyps and early malignancies is an increasingly utilised alternative to the conventional laparoscopic approach. Our robotic group wished to analyse surgical and oncological outcomes for our first ten R-TAMIS cases using the Da Vinci platform. Methods Data on consecutive R-TAMIS procedures over a 24-month period were prospectively collected and analysed. Post-operative rooms and clinic follow-up letters were also analysed to identify long-term complications. Results 10 patients (1:1 M/F), mean age 63.5 (51- 74) and mean BMI of 32.4 (22.8 – 44.5) underwent R-TAMIS using the Da Vinci Xi device. All cases were performed using the GelPOINT Path Platform. Two R-TAMIS were successfully performed by an ANZTBCRS fellow, utilising a dual-console system. Mean console time was 141 minutes (28 - 263). Resected lesions were a mean distance of 8 cm (6 -13) from the anal verge, and a mean of 51.7cm (15 – 95) in size. Five patients were demonstrated to have at least T1 adenocarcinoma, with the remainder having dysplastic lesions. Two patients failed to have their procedures completed with R-TAMIS, due to inaccurate pre-operative MRI staging, and two underwent subsequent successful completion laparoscopic low-anterior resection (LAR). One patient was found to have a dysplastic lesion only and avoided LAR after being diagnosed with invasive malignancy on preoperative biopsy. Two patients had reported complications (urinary retention and temporary faecal incontinence), and two had delayed discharges due to mobility issues. Conclusion Whilst R-TAMIS appears to be a viable and safe alternative to laparoscopic TAMIS and more invasive surgery for early rectal tumours, successful outcomes depend heavily on accurate pre-operative staging and ideally MDT discussion. It appears that R-TAMIS can also be taught safely to training fellows using appropriate teaching platforms.

Purpose: Surveillance following curative-intent oncological surgery aims to detect early recurrence while managing functional sequelae. For most malignancies, follow-up is guideline-based and delivered through MDT. However, in the context of radical or re-operative surgery such as pelvic exenteration (PE), robust procedure-specific surveillance guidance is lacking. This study aimed to evaluate the literature and characterise PelvEx surgeons’ perspectives on oncological and functional surveillance. Methodology: A literature search (Jan 00–Dec 24) identified studies reporting oncological and/or functional follow-up after PE. Data extracted included follow-up frequency and modality. A cross-sectional, questionnaire-based survey was disseminated via PelvEx – an international collaborative of PE specialists (Nov 24–Jul 25). Surgical demographics and experience were collected, and descriptive analyses summarised practice patterns. Results: Forty-two studies were included (39 cohort; 3 non-original). Oncological follow-up, described in 28 studies, recommended clinic visits every 3–4 months for 2–3 years, then annual review after 5 years. Frequencies of tumour markers, imaging, and endoscopies varied widely. Functional follow-up was addressed in 19 studies (often using EORTC QLQ-C30 and SF-36), but approaches were inconsistent. The survey received 176 responses from 32 countries (46% completion). Respondents were colorectal surgeons (71%) or surgical oncologist (21%), with median experience 14 years (IQR 8-20) and PE volume 15 cases/year (IQR 10-25). For surveillance, most reported outpatient review (91%), CEA (88%), CT (96%), and endoscopy (85%). Functional follow-up was less standardised, 50% of surgeons reviewed them outpatient, or 16% referred to other specialists. Conclusion: Both the literature and surgeon practice demonstrate marked heterogeneity – especially for functional follow-up – supporting development of consensus-based, MDT pathways after PE. Future studies should consider patient priorities and cost-effectiveness to guide collaborative standardisation.

Background: Unplanned hospital returns (UHRs), including readmissions and emergency department re-presentations, are common after colorectal cancer (CRC) surgery. Aotearoa New Zealand reports UHR rates at the upper end of international benchmarks, yet drivers remain poorly defined. Methods: This thesis used a mixed-methods design. A systematic review examined interventions investigated to reduce UHRs. A ten-year retrospective cohort study analysed UHR incidence, timing, causes, and predictors. Semi-structured qualitative interviews explored patient and whānau experiences of recovery. Findings were integrated to inform risk stratification and intervention design. Results: Among 801 patients, 17% experienced a UHR within 30 days, rising to 29% by 90 days. Most returns were inpatient readmissions, driven predominantly by complications including wound infection, stoma dysfunction, and ileus, as well as chemotherapy-related effects. Over 70% of returns were due to new issues, rather than complications recognised before discharge. Independent predictors included postoperative complications, stoma formation, and comorbidity. Qualitative analysis identified five themes influencing return behaviour: symptom uncertainty, unrealistic recovery expectations, disengagement with discharge information, reliance on whānau and community support, and difficulty accessing timely post-discharge care. A UHR Risk Score demonstrated effective stratification, with a four- to five-fold gradient in return risk. Conclusions: UHRs following CRC surgery in Te Tai Tokerau are frequent, multifactorial, and shaped by both clinical and psychosocial factors. Reducing preventable returns requires a bundled approach addressing peri-operative risk, discharge readiness, and post-discharge access. This thesis proposes the ReRAS (Reduction in Returns After Surgery) bundle as a pragmatic, context-appropriate strategy, with future work focused on prospective evaluation and external validation.