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Objective To evaluate the role of transvaginal ultrasound triage in women with a history of tamoxifen treatment who present with post-menopausal bleeding. Study design A retrospective review was undertaken of patients who presented with symptoms of post-menopausal bleeding and underwent ultrasound triage. Endometrial thickness and ultrasonographic features were then correlated with hysteroscopic and histopathological outcome data. The findings and outcomes for women with a history of tamoxifen use (tamoxifen group) were compared to those who had not taken tamoxifen (non-tamoxifen group). Results A total of 614 women with post-menopausal bleeding underwent transvaginal ultrasound triage, of whom 53 had a history of current or previous tamoxifen treatment. An endometrial thickness of ≥5 mm or the presence of other abnormal features was used to triage women to further investigation by hysteroscopy and biopsy. Endometrial thickness was significantly greater in the tamoxifen group (11 mm vs. 6 mm). Nearly all of the tamoxifen group were triaged to further investigation (98.1%), compared with significantly fewer in the non-tamoxifen group (68.3%) Overall, the incidence of endometrial pathology was also significantly higher in tamoxifen patients (43.4% vs. 31.7%). Conclusion For women presenting with post-menopausal bleeding, the use of transvaginal ultrasound as a triage tool is rarely helpful in evaluating women who have a history as tamoxifen use, as most will require further investigation with hysteroscopy and biopsy. A post-menopausal bleeding protocol that omits transvaginal ultrasound for women with a history of tamoxifen use may be an appropriate and effective pathway for managing these patients.

Introduction Liver resection offers the best curative treatment for hepatic metastases secondary to colorectal (CR) cancer. The aim of this study was to compare survival outcomes between patients having liver resection once (OR) versus those having redo-liver (RR) resection for hepatic metastases. Methods This was a retrospective study done on 171 patients who underwent hepatic resection (97 had OR & 74 had RR) from January 2009 to January 2020 across East Midlands hospitals. Results Mean age of patients in OR group was 75 years & RR group was 74. Male: female ratio was 2:1 for OR and 1.34:1 for RR group. Mean period between first and second liver resection was around 15.4 months. Minimum follow up period after surgery was 3 years. Up to the point of study till Jan.2023, overall there were 58 deaths reported out of a total of 97 patients in OR group, while in the RR group there were 39 deaths reported out of 74 patients. At 3 years follow up from initial resection, overall survival in OR patients was 58% while in the RR group was 65%. At 5 years follow up, overall survival in OR group was 40% while that of RR group was 45%. It was also noted that in the RR group, 67% (1/3) patients had lymph node positive disease (≥N1). Conclusion Beneficial outcome has been reported with regards to overall survival in patients undergoing redo hepatic resection and supports its role as the preferred choice of management for recurrent liver metastasis.