Introduction: Breast-conserving surgery (BCS) is the standard surgical approach for many women with early-stage breast cancer, offering survival outcomes that are at least equivalent to mastectomy when combined with adjuvant radiotherapy. The development of oncoplastic breast surgery (OBS) has broadened the scope of BCS by enabling wider tumour excision while maintaining breast contour, cosmetic outcomes, and patient satisfaction. Beyond aesthetic advantages, OBS has demonstrated improved oncologic outcomes, including lower rates of close or involved surgical margins and reduced need for re-excision. In rural Queensland healthcare settings, where access to reconstructive expertise and specialist services may be limited, evidence on OBS outcomes remains scarce. Objective: To evaluate whether the introduction of oncoplastic techniques improved surgical margin clearance and reduced re-excision rates following BCS in two rural Queensland Hospitals Methods: A retrospective cohort study was performed including all patients who underwent BCS for breast cancer at Bundaberg and Rockhampton Hospitals between 1 January 2020 and 31 June 2023. Patients were stratified according to the use of oncoplastic techniques. Data was collected through manual review of electronic medical records and included patient demographics, tumour characteristics, operative details, pathology results, margin status, and requirement for further surgery. Primary outcomes were surgical margin status and rates of re-excision. Secondary outcomes included types of re-excision (WLE vs mastectomy) and oncoplastic techniques Results: Data collection performed and analysis currently underway Conclusion This study evaluated the oncologic impact of oncoplastic breast surgery in two rural Queensland settings. Findings may support broader adoption of oncoplastic techniques in regional centres to optimise surgical margins, reduce re-excision and improve cosmetic outcome.

Rural acute surgical units in Western Australia (WA) are essential for Australians in rural areas but face significant challenges, including workforce shortages and geographical barriers. This review aimed to synthesize the current state of rural general surgery in WA—including caseload, scope of practice, and patient outcomes—to identify critical research gaps for improving service delivery. A narrative review of peer-reviewed literature, health service reports, and workforce data was conducted. The findings indicate that rural general surgeons manage higher procedural volumes and a broader scope of practice than their metropolitan counterparts. While many surgical outcomes are comp arable to urban centers, disparities persist in surgical oncology and trauma mortality, linked to access and transport delays. Key metrics such as unplanned returns to theatre (URTT) remain unquantified, and workforce shortages continue to hinder access to care. Significant research gaps exist regarding URTT rates, specific oncology outcomes, trauma morbidity, and the impact of access barriers, highlighting the need for targeted research to develop evidence-based strategies for equitable and sustainable surgical care in rural WA.

Background Soft tissue sarcomas (STS) are rare tumours that require multidisciplinary management at high-volume centres. The WA State Soft Tissue Sarcoma Service (WASTSS), established at Sir Charles Gairdner Hospital in 2016, provides a central referral pathway for rural patients. This study evaluated referral patterns and adherence to the Australian Cancer Council's optimal care pathway for people with sarcoma guidelines recommending specialist assessment within 4 weeks, investigations within 2 weeks, and surgery within 3 weeks of the decision to operate. Methods A retrospective analysis was conducted on 69 rural patients referred to WASTSS from 2020 to 2023. Data on demographics, referrals, and timelines were analysed. Statistical tests assessed adherence to guidelines and differences by patient and referrer location, malignancy status, and socio-economic factors. Results Annual referrals increased, with 88.2% of patients assessed within 4 weeks (median: 9 days). Investigations were completed within 2 weeks for 64.7% of patients (median: 7 days). Biopsy timing and location influenced investigation timelines. Only 37.5% of patients underwent surgery within 3 weeks, with delays linked to resource constraints and case complexity. Malignant cases experienced shorter delays than benign cases, with all malignant cases excised within 50 days; however, both groups exceeded recommended timeframes. Conclusion WASTSS met guidelines for initial assessments and investigations for rural patients in most cases. Delays in surgical management highlight the need for enhanced triage and resource allocation. Establishing dedicated benign tumour services and optimising diagnostic pathways could further improve outcomes.

Purpose Acute general surgery in regional Australia is frequently delivered by locum consultant surgeons. The breadth and acuity of this workload across multiple jurisdictions remain under-reported. This study describes the acute general surgery workload managed by a locum consultant surgeon across regional hospitals. Methodology A retrospective descriptive analysis was performed using a prospectively maintained consultant logbook documenting acute surgical procedures, including emergency presentations, undertaken between March and December 2025 across regional hospitals in Queensland, New South Wales, Victoria and South Australia. Procedures were categorised by diagnosis, operative approach and complexity. Results Acute surgical activity was dominated by appendicectomy and abscess drainage, including perianal, pilonidal, axillary and gluteal abscesses. Higher-acuity procedures included exploratory laparotomy, bowel resection, right hemicolectomy, perforated peptic ulcer repair and acute endoscopic intervention for upper gastrointestinal bleeding and food bolus obstruction. Short-term locum placements were characterised by high acute caseloads and limited elective activity, requiring broad procedural competence and independent decision-making across multiple subspecialty domains. Conclusion Locum consultant surgeons provide critical acute general surgery services across regional Australia, managing a wide spectrum of pathology including complex abdominal emergencies. These findings highlight the essential role of locum surgeons in sustaining regional acute surgical care.

Background Transanal minimally invasive surgery (TAMIS) is an established technique for local excision of complex rectal adenomas and selected early rectal cancers, predominantly performed in high-volume tertiary colorectal centres. Access to TAMIS in regional hospitals remains limited, often necessitating referral. We report the early experience of introducing TAMIS within a regional colorectal unit through structured collaboration with tertiary colorectal centres. Methods A retrospective analysis was conducted of consecutive patients undergoing TAMIS for rectal lesions at a regional referral hospital. Patient demographics, lesion characteristics, operative details, histopathology, peri-operative outcomes, and short-term follow-up were reviewed. All cases were discussed at a multidisciplinary team (MDT) meeting with input from tertiary colorectal services. Results Three patients underwent a total of four TAMIS procedures, including one staged diagnostic and definitive excision. Lesions were large sessile adenomas located in the low to mid rectum. TAMIS was successfully completed in all cases without conversion to alternative surgical approaches. Final histopathology demonstrated tubulovillous adenoma with low-grade dysplasia in all patients, with no invasive malignancy identified. One patient experienced a Clavien–Dindo grade II postoperative complication following a prolonged procedure. No readmissions or early recurrences were observed during short-term follow-up. Conclusion Transanal minimally invasive surgery can be safely and effectively introduced in a regional colorectal unit when supported by structured multidisciplinary governance and collaboration with tertiary colorectal centres. This model enables delivery of high-quality, organ-preserving surgery closer to home while maintaining oncological safety and appropriate escalation pathways. Collaborative regional–tertiary networks may represent an effective strategy for improving equity of access to advanced colorectal care.

Background: Access to specialist surgical services is a persistent challenge in rural and remote regions, contributing to health disparities. Innovative service delivery models are essential to bridge this gap. This study evaluates the effectiveness of a dual-clinic system—comprising a Rapid Access Clinic for acute assessments and a dedicated follow-up clinic —in a rural Western Australian setting.Methods: A retrospective analysis was conducted on patient visit data from the Rapid Access Clinic (n=564 visits) and the dedicated Outpatient Clinic (n=748 visits) between March 2023 and December 2024. Data on patient demographics, visit reasons, referral sources, and clinical outcomes were analysed to determine utilization patterns and service effectiveness.Results: The Rapid Access Clinic demonstrated a high-acuity caseload, with 22.5% of visits resulting in admission for surgery and 3.9% for monitoring. The clinic serves a broad demographic with a significant volume of referrals from local emergency departments (22.7%). A statistically significant inverse correlation was observed between age and surgical admission (r = -0.107, p = 0.011), with younger adults (18-34 years) having the highest rates of surgical intervention (31.3%). Abscesses were the most common condition leading to surgery (50.8% admission rate). In contrast, the outpatient clinic functioned primarily as a follow-up service, with a higher proportion of patients requiring multiple visits (36.1% vs. 18.9% at the Rapid Access Clinic) and minimal recorded admissions or discharges, indicating a focus on continuity of care. Conclusion:The dual-clinic model appears to be an effective strategy for delivering comprehensive surgical services in a rural setting. It combines rapid assessment for acute conditions with structured, ongoing management for chronic or post-operative issues. The findings highlight distinct successful integration with primary and emergency care services, offering a potential framework for other rural healthcare systems.

Aim: To evaluate the perioperative, pathological, and oncological outcomes of radical cystectomy performed at a single regional Australian centre over a 21-year period and assess whether outcomes align with those reported by higher-volume metropolitan centres. Method: A retrospective review was conducted of all patients who underwent radical cystectomy for primary bladder cancer between January 2002 and December 2023 at a regional centre in New South Wales. Patient demographics, surgical details, pathological findings, and survival outcomes were collected. Kaplan-Meier analysis was used to assess 5-year overall and disease-free survival. Results: A total of 138 patients underwent cystectomy (mean age 67.4 years; 78.3% male). Most received ileal conduit diversion (79.7%), followed by neobladder (19.6%). Final pathology included pT0 (21), pT1 (21), pT2 (39), pT3 (23), and pT4 (20). Lymph node dissection was performed in 98%, with a mean of 22 nodes removed. Positive surgical margins were present in 13.8%. Thirty-day mortality was 3.6% (n=5), due to causes including pulmonary embolism and myocardial infarction. Median length of stay was 11 days. Median follow-up was 44.8 months. Five-year overall survival and disease-free survival were 67% and 69%, respectively. Higher tumour stage correlated with increased mortality and shorter survival. Neoadjuvant chemotherapy was used in 38% of patients, with adjuvant chemotherapy in 9%. Conclusion: Outcomes of radical cystectomy at this regional centre are comparable to those of larger metropolitan centres. Routine pelvic lymph node dissection, structured perioperative care, and growing surgical experience contributed to favourable results. These findings support the delivery of complex urologic oncology care in regional settings.

Purpose/Introduction: To identify patient-reported barriers to breast reconstruction (BR) in eligible women using a prospective qualitative approach. Uptake to breast reconstruction remains low in regional populations despite known benefits. Limited data exist on the underlying patient-reported barriers to breast reconstruction in regional populations. Methods: A prospective qualitative study was conducted within a regional Australian health district. Women who were eligible for BR but did not undergo reconstruction between 2017–2022 were invited to participate (n = 227). A novel questionnaire was administered, incorporating Likert-scale items across six domains (information provision, access to services, logistical barriers, psychosocial factors, clinician communication, and expectations), with open-ended excerpts. Group differences were explored using chi-square analysis, and thematic analysis. Results: Many participants reported inadequate counselling regarding reconstructive options, limited access to subspecialist services, and significant logistical barriers including travel distance, cost, and waiting times. Over 70% of respondents stated reconstruction was not presented as a realistic or accessible option, and 64% felt insufficiently informed to make a confident decision. Prominent themes included fragmented referral pathways, poor continuity of care, and perceptions of reconstruction as cosmetic only. Several patients described changes in treating surgeons, lack of coordinated follow-up, and believed further corrective surgery would require private payment. Conclusion: Regional women face systemic and informational barriers to breast reconstruction extending beyond clinical eligibility. Patient-reported experiences highlight gaps in counselling, referral pathways, and service continuity. These findings support the need for structured multidisciplinary counselling, improved regional reconstructive access, and clearer framing of reconstruction as a component of oncologic care.