Noel Cassar - Academia.edu (original) (raw)

Papers by Noel Cassar

Hpb, 2019

preoperative chemotherapy(P=.011), and no postoperative chemotherapy(P=0.31) independently predic... more preoperative chemotherapy(P=.011), and no postoperative chemotherapy(P=0.31) independently predicted worse OS. Conclusion: Liver resection for PLM is feasible and safe and may be recommended within the framework of an individualized cancer therapy. Multimodal treatment including hepatectomy and systemic therapy may provide prolonged survival in selected patients with metastatic pancreatic cancer.

The Surgeon, 2022

Management of patients with colorectal liver metastases has evolved considerably due to a better ... more Management of patients with colorectal liver metastases has evolved considerably due to a better understanding of the biology of the disease with concurrent improvements in surgical techniques, oncological strategies and radiological interventions. This review article examines the factors that have contributed to this radical change. Management will be discussed in relation to chemotherapy, surgery and interventional radiology. The addition of chemotherapy and biological agents has greatly extended the reach and scope of surgery. Parenchymal sparing resections, repeat resections, two stage hepatectomy and Associating Liver Partition and Portal Vein ligation are all available to the hepatobiliary surgeon who deals with colorectal liver metastases. Interventional radiology techniques like liver venous deprivation may also replace established surgical practice. Whilst traditionally it was thought that only a few liver metastases could be treated effectively, nowadays tumour number is no longer a limiting factor provided enough functioning liver can be spared and the patient can tolerate the operation.

Malta Medical Journal Volume 27 Issue 01 2015 Abstract Objective: The ideal excision margin in br... more Malta Medical Journal Volume 27 Issue 01 2015 Abstract Objective: The ideal excision margin in breast conserving surgery is still a matter of debate. We aim to see if there is any correlation between increasing excision margin distance and local recurrence rate. Materials and Methods: Patients who had breast conserving surgery at Mater Dei Hospital in 2009 had their notes reviewed retrospectively. Patient demograpichs, including the excision margins were recorded. Local recurrences within a 3 year follow up period were noted. Chi square was used to compare categorical data and a p value of less than 0.05 was considered statistically significant. Result: 91 patients were recruited into the study. 74 patients (81.5%) had negative margins (>1mm), 10 patients (11%) had close margins (<1mm) while 7 patients (7.5%) had positive margins. 5 patients (5.5%) had local recurrence. The highest recurrence rate (14%) was in patients with positive margins, and no statistical signficant diffe...

Malta Medical Journal

Aim: Patients undergoing bypass graft placement in the lower limb are often entered into a graft ... more Aim: Patients undergoing bypass graft placement in the lower limb are often entered into a graft surveillance programme using duplex scanning. The aim of this programme is to identify stenoses in vein grafts before they become symptomatic and treat these by angioplasty or surgery, thus prolonging the patency of the graft. This paper aims at reporting on the progress and viability of this programme at Mater Dei Hospital, Malta. Method: Infrainguinal bypass grafts carried out between July 2007 and May 2009 were enrolled. Scanning starts during the patient's in-hospital stay at one week post-operation. It is then scheduled at 6 weeks, 3 months, 6 months, 12 months, 18 months, 24 months, and yearly afterwards. When a significant stenosis is encountered, the patient is referred for angioplasty. Surgery would be considered in cases when angioplasty is not an option. Results: During this period 56 patients were recruited. At one week post-op the patency rate was 100%. At 6 months the primary unassisted patency was 77.5% while the primary assisted patency was 87.5%. At 12 months the primary unassisted patency was 50% while the primary assisted patency was 77%. Secondary patency rates at 6 and 12 months were 95% and 82% respectively. Conclusion: The graft surveillance programme ensures that any problem detected in the post-operative period is dealt with as soon as possible. The study shows that this programme is being effective in that assisted rates (i.e. after angioplasty or surgery) are better than unassisted rates.

BMJ, 2010

On examination he was well, with a blood pressure of 140/80 mm Hg and a pulse of 80 beats/min, wh... more On examination he was well, with a blood pressure of 140/80 mm Hg and a pulse of 80 beats/min, which was regular and of good volume. He had normal heart sounds and normal peripheral pulses in the upper limbs and in the left leg but absent pulses distal to the ...

HPB

information on the intraoperative drain placement, drain amylase level on postoperative day one (... more information on the intraoperative drain placement, drain amylase level on postoperative day one (POD1), postoperative day of last drain removal and patients with POD1 amylase level > 5000 U/L were also excluded. Patients with early drain removal (3 days) were compared to those with late drain removal (4 days). Multi-variable regression models were used to evaluate the possible benefit of early drain removal after adjustment for multiple confounding factors. Results: 1066 patient were eligible for analysis. Patients with early drain removal had significantly lower mean rates of serious postoperative complications (p< 0.001), overall morbidity (p< 0.001), pancreatic fistula (p< 0.001), organ space infection (p=0.007), delayed gastric emptying (DGE) (p=0.026) and shorter mean in-hospital stay (p< 0.001). After adjustment for many confounding factors with multivariable regression models, the early group continued to have a significantly lower risk of all noted complications, except postoperative DGE. Conclusion: Early removal (3 days)of the drain after Whipple procedures is associated with lower rates of postoperative adverse outcomes when POD 1 drain amylase levels are < 5000 U/L.

Journal of Clinical Medicine

Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in childr... more Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Methods: Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Results: Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS...

Hepatobiliary & Pancreatic Diseases International

Pediatric Transplantation

International journal of colorectal disease, 2017

A potentially resectable bony metastasis in the context of oligometastatic colorectal cancer is u... more A potentially resectable bony metastasis in the context of oligometastatic colorectal cancer is uncommon. Bony metastases are usually considered a late event with poor prognosis and generally associated with liver and/or lung metastases. A previously healthy 33-year-old gentleman, with no family history of colorectal cancer, presented with rectal bleeding and at colonoscopy had a biopsy-proven adenocarcinoma of the rectum, 7 cm from the anal verge. Imaging also showed an isolated bone metastasis in the left ischial tuberosity. Following recovery from an anterior resection and a segment 5 metastasectomy, he underwent resection of the bony metastasis with a left type 3 internal hemipelvectomy. Three years from the bony resection, there is no evidence of recurrence on imaging. Osseous metastases are usually treated with palliative intent with bisphosphonates or external radiation, with surgical fixation of pathological fractures in some cases. Median survival after diagnosis of bone me...