Until recently, cancer of the oesophagus was a very uncommon tumour in Australia and other western populations. However during the past three decades, there have been very large increases in the incidence of this disease. Indeed, rates of oesophageal cancer have risen faster than any other cancer in the United Statesand similar dramatic increases in incidence have been observed in Europe and Australia. With increasing population prevalence of the causes of cancer of the oesophagus in western soc ....Until recently, cancer of the oesophagus was a very uncommon tumour in Australia and other western populations. However during the past three decades, there have been very large increases in the incidence of this disease. Indeed, rates of oesophageal cancer have risen faster than any other cancer in the United Statesand similar dramatic increases in incidence have been observed in Europe and Australia. With increasing population prevalence of the causes of cancer of the oesophagus in western societies (namely acid reflux, obesity and poor diet), there are strong grounds for predicting that incidence will continue to rise, and that oesophageal cancer will constitute an increasingly large burden on society. Unfortunately, treatment options are limited, survival is often short, and there is no way of identifying which tumours will respond to therapy. This proposal will collect treatment and health outcomes data for a population-based cohort of patients with oesophageal cancer. The goal is to identify prognostic and predictive markers to aid patients and clinicians when making treatment decisions, as now exist for breast cancer. Such markers may also serve as novel targets for therapy. The proposed study builds upon the platform of the Australian Cancer Study [ACS], one of the world's largest studies of oesophageal cancer. This represents a unique opportunity to investigate a pressing clinical problem by building upon a study of acknowledged international importance.Read moreRead less
Australasian Randomised Clinical Trial Comparing Laparoscopic And Open Surgical Treatment Of Colon Cancer: Follow-up.
Funder
National Health and Medical Research Council
Funding Amount
$233,000.00
Summary
Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 15 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen ....Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 15 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen of the gall bladder is then used to guide instruments to remove the gall bladder without making a large incision in the abdominal wall. This is called a laparoscopic cholecystectomy. The safety of a laparoscopic assisted approach in the removal of colon cancer is yet to be determined. This study will compare the long term and short term outcomes of people who have colon cancers removed whether by laparotomy ( a cut in the midline of the abdominal wall) or by a laparoscopic assisted approach (telescope).Read moreRead less
AUSTRALASIAN MULTICENTRED PROSPECTIVE RANDOMISED STUDY OF LAPAROSCOPIC VS CONVENTIONAL SURGICAL TREATMENT OF COLON CA
Funder
National Health and Medical Research Council
Funding Amount
$495,000.00
Summary
Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 10 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen ....Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 10 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen of the gall bladder is then used to guide instruments to remove the gall bladder without making a large incision in the abdominal wall. This is called a laparoscopic cholecystectomy. The safety of a laparoscopic assisted approach in the removal of colon cancer is yet to be determined. This study will compare the long term and short term outcomes of people who have colon cancers removed either by a laparotomy (a cut in the midline of the abdominal wall) or by a laparoscopic assisted approach (telescope).Read moreRead less
Acute pancreatitis is an acute abdominal inflammatory process (the pancreas attempts to digest itself) with significant mortality in those patients having the severe form of the disease. The commonest causes of the disease are gallstones and excessive alcohol consumption. Approximately 80% of patients with acute pancreatitis recover, but 20% experience the severe form of the disease. In severe pancreatitis, 30% of patients die. Severe pancreatitis is associated with necrosis (cell death) of the ....Acute pancreatitis is an acute abdominal inflammatory process (the pancreas attempts to digest itself) with significant mortality in those patients having the severe form of the disease. The commonest causes of the disease are gallstones and excessive alcohol consumption. Approximately 80% of patients with acute pancreatitis recover, but 20% experience the severe form of the disease. In severe pancreatitis, 30% of patients die. Severe pancreatitis is associated with necrosis (cell death) of the pancreas which, results from reduced blood flow in the organ. This reduced blood flow may be secondary to increased pressure in the pancreatic duct following occlusion of the duct. Preliminary studies suggest that the reason why the pancreas may be susceptible to necrosis is the anatomical arrangement of its blood supply, being made up of many end arterioles (very small arteries) that do not connect with other arteries. The consequence of this arrangement is that if a particular end arteriole becomes blocked, the area of the tissue cannot obtain a blood supply from neighbouring arterioles (as in other organs). Blood supply is partly controlled by nerves. The nerve transmitter nitric oxide is one of the major chemicals involved in this regulation. Nitric oxide also regulates the pressure in the pancreatic duct by acting on the sphincter of Oddi, situated at the opening of the pancreatic duct. Consequently, the action of nitric oxide during pancreatitis may be crucial to the development of the severe disease. This proposal seeks to define the blood supply of the pancreas, its regulation, the effect that increased pancreatic duct pressure has on it and the role that nitric oxide plays in this. If the hypotheses regarding the role of nitric oxide on pancreatic blood flow is proven, then drugs which influence nitric oxide levels can be used to limit the production of pancreatic necrosis. In turn, such an effect will reduce the mortality and morbidity of acute pancreatitis.Read moreRead less
The Quality Of Surgical Care Project: Quality Assurance, Clinical Audit And Outcomes Evaluation In Western Australia
Funder
National Health and Medical Research Council
Funding Amount
$346,018.00
Summary
The Quality of Surgical Care Project (QSCP) is a unique quality assurance program in Australia which promotes best practice in surgical and procedural care. The objectives of the QSCP are to evaluate the outcomes of surgical procedures in Western Australia (WA) and to compare them with international standards. The QSCP was established in 1996, as a collaborative venture among the Royal Australasian College of Surgeons (RACS), the Department of Public Health, (UWA) and the Health Department of WA ....The Quality of Surgical Care Project (QSCP) is a unique quality assurance program in Australia which promotes best practice in surgical and procedural care. The objectives of the QSCP are to evaluate the outcomes of surgical procedures in Western Australia (WA) and to compare them with international standards. The QSCP was established in 1996, as a collaborative venture among the Royal Australasian College of Surgeons (RACS), the Department of Public Health, (UWA) and the Health Department of WA. The QSCP is only possible because of the unique population-based record linkage available in this state and is consistent with priorities identified in the National Health Information Development Plan in the areas of record linkage and health outcomes, as well as with the monitoring of interventions recommended by the Taskforce on Quality in Australian Health Care. The surgical procedures reviewed are selected to include a broad range of surgical specialties on the basis of national priority, in consultation with the RACS and with input from the Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S). This application proposes to continue the core program in promoting best practice in procedural care by reviewing selected procedures including the outcomes of laparoscopic and endoscopic procedures, and endoluminal stenting surgery due to their rapid proliferation during the 1990's. This second stage of the QSCP proposes the introduction of two new quality assurance themes. Firstly, to promote the clinical safety and post-implementation surveillance of new surgical interventions and other medical technology by establishing the WA Registry and Surgical Audit of New Surgical Interventions. Secondly, to comprehensively and independently audit all surgical mortality at a population level. A dissemination strategy will be established to 'complete the loop' in the evaluation and audit processes.Read moreRead less
The Neurovascular Territories Of The Human Body: Anatomic Study And Clinical Applications
Funder
National Health and Medical Research Council
Funding Amount
$186,650.00
Summary
A Melways Roadmap of the anatomy of the large and small nerves, arteries and veins of the human body is underway and will take a further three years to complete. The aim is to evolve or modify Reconstructive Plastic Surgery techniques taking tissue from a hidden site and, where possible, include a nerve supply with the transplant so that feeling can be restored to skin flaps and function to transferred muscle. The fundamental objective is to improve the quality of the patients life. We have alre ....A Melways Roadmap of the anatomy of the large and small nerves, arteries and veins of the human body is underway and will take a further three years to complete. The aim is to evolve or modify Reconstructive Plastic Surgery techniques taking tissue from a hidden site and, where possible, include a nerve supply with the transplant so that feeling can be restored to skin flaps and function to transferred muscle. The fundamental objective is to improve the quality of the patients life. We have already completed a thorough examination of the following regions: (i) head and neck (ii) forearm (iii) leg These have received international acclaim and awards. We are currently examining: (i) hand and foot (ii) thigh and buttock. Still to be commenced: (i) arm and shoulder (ii) torso (iii) back. Reconstructive surgery involves the treatment and the reconstruction of defects throughout the whole human body. These defects may arise in any member of the family. With modern reconstructive techniques a problem can often be solved in one operation thus avoiding multiple operations and long periods of hospitalisation which can be devastating to both patient and family. These new techniques nevertheless have demanded a reappraisal of the basic sciences, especially the anatomy of the blood and nerve supply to the potential transplant. This is essential so that they can be designed with not only precision and safety but in such a way that there is minimal disability at the donor site. As well as restoring shape and form, the patient can have tremendous improvement in quality of life and independence if function is also restored. In order to provide function (feeling and movement) a working nerve supply must be included in the reconstruction. Therefore our research must continue to investigate the complex patterns of nerve supply to tissues of the body and correlate this information with the blood supply which is needed to keep the tissue alive.Read moreRead less
Ablative Therapies For Barrett's Oesophagus - Evaluation Of New Clinical And Experimental Therapies
Funder
National Health and Medical Research Council
Funding Amount
$302,310.00
Summary
Barrett's oesophagus arises when repeated episodes of gastro-oesophageal reflux lead to the oesophageal lining undergoing change to a lining more like that of the intestine. This new lining predisposes to cancer, a problem which is rapidly becoming more common. Recent research has focused on techniques which could reverse this process. Destruction (ablation) of Barrett s oesophagus can be followed by regeneration with a normal looking lining. A range of techniques have been used for this. Howeve ....Barrett's oesophagus arises when repeated episodes of gastro-oesophageal reflux lead to the oesophageal lining undergoing change to a lining more like that of the intestine. This new lining predisposes to cancer, a problem which is rapidly becoming more common. Recent research has focused on techniques which could reverse this process. Destruction (ablation) of Barrett s oesophagus can be followed by regeneration with a normal looking lining. A range of techniques have been used for this. However, the behavior of the regenerated lining is unknown, and there still remains potential for cancer. We are currently evaluating endoscopic ablation using Argon Plasma Coagulation within clinical trials. There is also scope for the development of better approaches to ablation. We hypothesize that an suitable liquid has the potential to more evenly and more easily ablate the lining. Delivery of a liquid substance to lower oesophagus can be achieved through a tube which confines liquid to the lower oesophagus. However, to make this approach acceptable it is necessary to determine the best treatment agent, and to test the delivery system. We will first do this using animal models, before future application in patients. A further key issue is whether the cells which repopulate the oesophagus are genetically normal or abnormal. After ablation it is likely that the cells which repopulate the lining are sourced from the same cells which were the source of the abnormal lining, and these cells could inherit genetic alterations. This could increase the risk of cancer. Hence, we plan to assess certain genes in biopsies taken from tissue before and after ablation to determine genetic normality. In Australia endoscopic ablative techniques are currently being introduced into clinical practice without evaluation. Hence the question of whether ablation actually reduces the risk of cancer and how to best perform ablation should be addressed before clinical application becomes widespread.Read moreRead less
Association Between Obesity, TGFb, Thrombospondin And Small Abdominal Aortic Aneurysm Progression.
Funder
National Health and Medical Research Council
Funding Amount
$514,777.00
Summary
Abdominal aortic aneurysm (AAA) is an important cause of mortality in middle aged and elderly Australians. The incidence of AAA continues to increase despite improvements in the medical management of atherosclerosis. We postulate that obesity is important in the progression of AAA. In a community screening study we found that waist-hip ratio was independently associated with AAA. In this project we investigate the mechanisms underlying this association between obesity and AAA.
Perioperative Beta-blockade To Prevent Cardiac Morbidity In High-risk Patients Undergoing Surgery (The POISE Study)
Funder
National Health and Medical Research Council
Funding Amount
$189,625.00
Summary
Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a subst ....Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a substantial group of patients are therefore at risk of an adverse outcome following surgery. Despite the magnitude of this problem, however, few studies have established treatments to decrease the risk of complications and death following surgery. Beta-blockers are a group of drugs which have been used for decades in the treatment of heart disease and high blood pressure. Beta-blockers are known to improve the way the heart copes with the stress of surgery. They decrease the heart rate, make the heart more efficient at using energy and reduce the likelihood of imbalance between oxygen supply and demand. Some previous studies showed that beta-blockers may reduce the risk of heart attack and death for up to 2 years after surgery. However, other studies have shown no effect of beta-blockers on outcome. These previous studies have involved small numbers of patients who may not represent the broader population having surgery. We therefore propose to undertake a large trial to definitively answer the question about whether beta-blockers improve the outcome after non-cardiac surgery in patients with, or at risk of, heart disease. Even if the effect of beta-blockers is relatively modest, because such large numbers of patients with heart disease have surgery, the overall effect on the rate of complications and death in the population could be very significant. The results of this study could have major implications for the success of, and cost of, surgery worldwide.Read moreRead less