bluuebunny/crossref_metadata_2025 huggingface dataset:
O066 Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms – a 10-year longitudinal cohort study
Authors: Laloo R , Aimar K , Khanom J , Bailey M , Scott J
Published: November 2022

Introduction

European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study assessed outcomes following IAA rupture as their natural history is poorly understood with recommendations based on low-level evidence.

Methods

Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data

collection performed. The primary outcomes included aneurysm rupture, rupture diameter, postoperative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.

Results

Of 203 patients included, 90.6% were men and median (IQR) age at detection was 77(71–83). Comorbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4) cm for CIA and 4.6 (3.0) cm for IIA. Post-operative major adverse cardiovascular events more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).

Conclusion

Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.

Take-home message

Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms.
O068 EVAR Gore salvage fabric technique (ARAFAT) to salvage evar fabric fatigue and graft failure
Authors: Sultan S , Acharya Y , Hynes N
Published: November 2022

Introduction

EVAR GORE SalvAge Fabric Technique (ARAFAT) is an innovative management protocol to seal material graft failure due to type IIIb endoleak (EL) in patients who are mainly at high risk for open conversion. We aim to discuss ARAFAT, an innovative management protocol to seal material graft failure due to type IIIb endoleak (EL).

Methods

We employed ARAFAT in patients following type IIIb EL to salvage previous EVAR with a polyester-based stent graft. The ARAFAT principle relies on the use of polytetrafluoroethylene (PTFE) and the realignment of the polyester stent graft for sealing the microleaks and aortic sac hygroma, resulted due to polyester filtration. First, an oversized EXCLUDER® aortic cuff (GORE®, Flagstaff, Arizona, USA) is deployed into the previously implanted polyester-based stent graft. This is followed by simultaneous deployment of an EXCLUDER® iliac extension, as necessary, in double barrel configuration from the main cuff. A minimum of 2 cm of a distal seal zone is provided to promote stability.

Results

ARAFAT was employed in 18 patients (mean age 80 ± 6.86 years; 77% male). The average size of the aortic sac that underwent re-intervention was 6.68 ± 2.13 cm. All the patients had primary technical success. There was no peri-operative mortality. The average follow-up was 35.6 ± 6.24 months.

Conclusion

We successfully employed the ARAFAT technique as a fully functioning protocol to overcome apparent challenges in managing material fatigue graft failure EL in high-risk patients.

Take-home message

EVAR GORE Salvage Fabric Technique (ARAFAT) technique could be successfully employed as a fully functioning protocol to overcome apparent challenges in managing material fatigue graft failure EL in high-risk patients.
O069 Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates
Authors: Laloo R , Gadsby G , Jauniaux B , Bailey M , Scott J
Published: November 2022

Introduction

Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near anastomosis. This study assesses graft surveillance uptake, patency, amputation and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12-months postoperatively.

Methods

Patients undergoing infra-inguinal bypass at a single vascular centre between 1st January 2018 and 31st December 2019 were identified from the prospectively collected database. Primary outcomes at 1, 6 and 12-months postoperatively included: duplex-ultrasound (DUS) surveillance uptake, patency, major amputations and death rates. Statistical analysis with SPSS® was performed using chi-squared tests and paired sample t-tests.

Results

Of the 91 patients included, 79.1% were men and median (IQR) age was 71(62–76). At 1, 6 and 12 months, DUS uptake was 74.2%, 77.5% and 73.3% respectively, primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Patients on statin therapy post-operatively had lower 12-month mortality than those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy (6.3% vs 40%, p=.008).

Conclusion

DUS graft surveillance is a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation to reduce 12-month major amputation and mortality rates.

Take-home message

Infra-inguinal bypass graft surveillance is an opportunity to optimise statin and antiplatelet therapy to reduce 12-month major amputation and mortality rates.
O071 An innovative prone contrast enhancement computed tomography angiography (PASHA) protocol to diagnose concealed endoleak and aortic sac hygroma
Authors: Sultan S , Acharya Y , Hynes N
Published: November 2022

Introduction

Standard 4-phase supine computed tomography angiography (CTA) scans are unable to detect smaller fabric tear (< 1–2 mm) following EVAR, which are erroneously interpreted as type IV or V endoleak (EL). Here, we propose a novel diagnostic technique, ‘Prone contrASt enhanced computed tomography Angiography’ (PASHA)' that uses time-resolved four-phase CTA protocol to detect and classify concealed ELs.

Methods

We employed PASHA protocol in 46 patients after continuous sac expansion following primary EVAR where the standard 4-phase CTA could not identify the EL source. PASHA protocol uses a prone position during standard 4-phase CTA, which displaces the aorta anteriorly by approximately 5 mm, shortening the anterior cortex distance and allowing fluid transudation due to gravity with maximal EL enhancements.

Results

The average numbers of CT scans performed before diagnosing EL with PASHA protocol were 3.4 ±1.5 (range: 1–6). PASHA protocol demonstrated EL in all 46 cases that the standard supine 4-phase CTA could not identify. PASHA protocol effectively enhanced the degree of contrast infiltration into the aortic sac in all the patients.

Conclusion

PASHA is a multi-phase positional CTA technique that enhances the degree of contrast infiltration into the aortic sac when micro-leaks are present, increasing the EL detection rate following EVAR and strategically mapping successful future intervention.

Take-home message

Prone contrASt enHanced computed tomography Angiography (PASHA) is a multi-phase positional computed tomography angiography (CTA) technique that enhances the degree of contrast infiltration into the aortic sac when micro-leaks are present. PASHA increases the endoleak (EL) detection rate following endovascular aneurysm repair (EVAR) and strategically maps successful future interventions.
O072 A 10-year longitudinal cohort study assessing growth rates and surveillance intervals for common iliac artery aneurysms
Authors: Laloo R , Aimar K , Khanom J , Bailey M , Scott J
Published: November 2022

Introduction

European Society for Vascular Surgery defines common iliac artery (CIA) aneurysms as greater than 1.8cm in men and 1.5cm in women. Reported growth rate is 1–4mm/year depending on their diameter. This study assessed the natural history and surveillance intervals for CIA aneurysms as intervention threshold is based on low-quality evidence.

Methods

Patients with an IAA at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included diameter-based mean aneurysm growth rates and median surveillance intervals. Statistical analysis with SPSS® was performed using chi squared tests.

Results

Of 203 patients included, 90.6% were men and median (IQR) age at detection was 77(71–83). IAA were located in the CIA (85.2%), IIA (21.7%) and EIA (2.0%) with the majority being asymptomatic (78.8%). CT was most frequently used as the imaging modality for IAA surveillance (66.3%), followed by ultrasound scan (29.8%) and MRA (3.9%). Growth rate for CIA aneurysms measuring 1.0–1.9cm were -2.1mm/year, 2.0–2.9cm were 0.8mm/year, 3.0–3.9cm were 3.5mm/year, 4.0–4.9cm were 9.4mm/year, 5.0–5.9cm were 2.9mm/year and >6.0cm were 13.8mm/year. Median surveillance intervals for CIA aneurysms at 1.0–1.9cm were 12-monthly, 2.0–2.9cm were 11-monthly, 3.0–3.9cm were 5-monthly, 4.0–4.9cm were 5-monthly, 5.0–5.9cm were 5.5-monthly and >6.0cm were 14.5-monthly. Mean (SD) CIA diameter at rupture was 4.6 (2.4)cm.

Conclusion

CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance and consideration for repair prior to rupture.

Take-home message

CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance and consideration for repair prior to rupture.
O075 Antithrombotic therapy for aortic and peripheral artery aneurysms: a systematic review and meta-analysis
Authors: Wong KHF , Zlatanovic P , Bosanquet DC , Aboyans V , Saratzis A , Kakkos SK , Hinchliffe RJ , Twine CP
Published: November 2022

Introduction

The role of antithrombotic agents in aneurysm progression and outcomes following surgical or endovascular intervention is unclear.

Methods

A systematic review and meta-analysis was performed. Medline, Embase, and CENTRAL databases were searched. Randomised-controlled trials and observational studies investigating the effect of antithrombotic therapy on clinical outcomes for patients with aortic or extracranial peripheral arterial aneurysms were included. Aneurysm growth rate, major adverse cardiovascular or limb events, mortality, endoleaks, re-intervention rates, and other outcomes were captured.

Results

Fifty-seven studies involving 121,451 patients were included (26 antiplatelets, 12 anticoagulants, 16 any antithrombotic agent(s), 2 intra-operative heparin). Aspirin reduced growth rates of aortic aneurysms under surveillance (mean difference -0.9mm/y, 95%CI -1.74 to -0.07, p=0.03; GRADE certainty: moderate). For aortic aneurysms undergoing intervention, anti-thrombotics increased 30-day mortality (odds ratio [OR] 2.30, 95%CI 1.51 to 3.51, p<0.001; GRADE certainty: moderate). Antiplatelets reduced long-term all-cause mortality (hazard ratio [HR] 0.84, 95%CI 0.76 to 0.92, p<0.001; GRADE certainty: moderate), whilst anticoagulants increased this risk (HR 1.64, 95%CI 1.14 to 2.37, p=0.008; GRADE certainty: very low). Anticoagulants increased incidence of endoleaks under 3 years, and re-intervention rates (p<0.05 for all). Antithrombotic agents did not significantly affect rupture rates in aortic aneurysms. Meta-analysis was not possible for ruptured aneurysms and popliteal aneurysms.

Conclusion

There is moderate quality evidence that aspirin reduces aneurysm growth rates. Antiplatelet agents reduced all-cause mortality in aneurysms after intervention; whilst anticoagulants increased this risk, along with endoleaks and re-interventions. Well-designed trials are required to determine therapeutic benefits of antithrombotic agents for patients with aneurysms.

Take-home message

Antiplatelets may have a role in reducing aneurysm growth rates and all-cause mortality; whilst anticoagulants are associated with increased mortality, endoleaks, and re-interventions. Well-designed trials are required to determine therapeutic benefits of antithrombotic agents for patients with aneurysms.
O076 Long term outcomes of “Christmas tree” banding for the treatment of dialysis access related steal syndrome: a thirteen-year experience with the technique
Authors: Ravindhran B , Totty JP , Carradice D , Chetter IC , Smith GE
Published: November 2022

Introduction

High flowrates in arterio-venous fistulas (AVF) and the associated distal arterial insufficiency can cause Dialysis-Access related Steal Syndrome (DASS). Various techniques including ligation, banding, and bypass with interval-ligation have been advocated to treat this difficult problem with varying success. We present the long-term outcomes following a novel banding technique.

Methods

46 patients in this prospective cohort-study from 2008–2021 underwent an adjustable banding procedure using a PTFE patch shaped with one slit-end and saw-tooth edges (resulting in a ‘‘Christmas tree’’ pattern) to provide a ratchet mechanism to progressively constrict the draining vein. Real-time finger perfusion pressure monitoring allowed an optimal compromise between distal extremity and AVF perfusion. Comparisons between groups were measured and survival curves were obtained using the Kaplan-Meier method based on the log-rank test to calculate the thrombosis-free survival.

Results

63%(n=29) presented with constant pain and 24%(n=11) presented with tissue loss due to steal syndrome. Post-intervention patency was 100%,97.7%,95%,86% and 72% at 30 days, 60 days, 180 days, 1 year and 3 years, respectively. Complete resolution of symptoms was achieved in 74%(n=34) of patients and 11%(n=5) reported partial response needing no further intervention. We also observed that pre-procedure finger pressures of 41mmHg or below was highly specific for “true” steal-syndrome and these patients were more likely to completely respond to banding (p=0.016). The overall mean thrombosis free survival was seen to be 1844±168 days.

Conclusion

This adjustable dynamic method of AVF banding demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.

Take-home message

The described adjustable dynamic method of AVF banding under local anaesthesia demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.
O079 Predictive value for elevated platelet-derived SGPVI in venous in-stent stenosis in patients with post-thrombotic syndrome
Authors: Gwozdz AM , Black SA , Bye AP , Gibbins JM , Patel AS , Modara B , Smith A , Saha P
Published: November 2022

Introduction

In-stent stenosis following intervention for post-thrombotic syndrome (PTS) occurs in ∼30% of cases, despite therapeutic anticoagulation. Our aim was to investigate whether platelets are involved.

Methods

Blood was taken from case-matched patients before and after venous stenting. Flow-cytometry was used to assess platelet activation (P-selectin and/or phosphatidylserine exposure) while= functional activity was measured by plate-based aggregation and through a flow-cell model of thrombus formation. Soluble glycoprotein VI (sGPVI) was measured in plasma. Patients with in-stent stenosis requiring reintervention (>50% diameter reduction) were compared with those who did not.

Results

Forty-five patients were recruited (median age: 43yrs (33–55yrs); 65% female), and 19/45 (42%) required reintervention (median time: 3wks (1day-3mths)). There was no difference in platelet activation or reactivity after stenting, but P-selectin exposure pre-stent was significantly higher in patients who developed in-stent stenosis (2.7%±0.4 vs 1.7%±0.2; P<0.05). Pre-stent sGPVI levels were increased in patients who developed in-stent stenosis (18.9±3.6ng/mL vs. 7.4±0.9ng/mL; P<0.01). Platelet reactivity to collagen-related peptide, a GPVI-specific platelet agonist, was reduced in patients who developed in-stent stenosis (logEC50 = -6.5M±0.3 vs -7.2M±0.2; P<0.05; n=33). Pre-stent platelet accumulation (26.6AU±0.5 vs 19.0AU±8.1; P=0.04) was significantly increased in PTS patients compared with healthy controls.

Conclusion

Venous stenting does not activate platelets, but patients who developed in-stent stenosis exhibited greater levels of pre-stent platelet activation, greater loss of platelet surface GPVI in the form of sGPVI and reduction in reactivity to GPVI activation. sGPVI may have potential to risk stratify patients undergoing venous stenting and predict who requires closer surveillance.

Take-home message

Soluble GPVI may have potential to risk-stratify patients undergoing deep venous reconstruction and predict who requires closer surveillance.
O082 Patient derived renal cell carcinoma tumouroids for personalised renal cancer medicine
Authors: Bokea K , Azimi T , Stamati K , Yaghini E , Macrobert S , Cheema U , Tran M , Feber A , Loizidou M
Published: November 2022

Introduction

Despite the significant advancements in the therapeutic management of renal cell carcinoma (RCC), there is still a pressing need for patient-specific platforms that can predict personalised treatment response. This study aims to optimise renal cancer tumouroids: 3D in vitro models that mimic the tumour density, and incorporate primary cells isolated from RCC surgical specimens and extracellular matrix components to recapitulate the tumour microenvironment.

Methods

RCC samples were collected post-surgery (n=16), disaggregated using different methods and the isolated cells were grown in 2D and tumouroids. Cell proliferation was compared among different culture conditions by measuring ATP production. Tumouroids were also challenged with a clinically used tyrosine kinase inhibitor, pazopanib. Immunofluorescence and confocal microscopy were used to detect expression of RCC markers and whole-exome sequencing was performed to investigate tumouroids’ resemblance to the parental tumour.

Results

Patient-derived RCC tumouroids retain the expression of renal cancer associated gene markers, including mutant VHL, and protein markers, including cytokeratins and epithelial-tomesenchymal markers. A non-linear increase in proliferation was observed in the tumouroids which may be indicative of 3D organization and other cellular functions. Tumouroids’ response to pazopanib ranged from none to strong (40%) and tumouroids of higher complexity, that incorporated a stromal compartment, responded stronger than simpler tumouroids (n=3).

Conclusion

Our results indicate that RCC cells maintain their phenotype and genotype when grown as tumouroids. Future work will compare the response from tumouroids to the responses from both xenografts and the actual patients to determine the suitability of tumouroids as personalised cancer treatment platforms.

Take-home message

Renal Cell Carcinoma cells isolated from human patients maintain their phenotype and genotype when grown in biomimetic tumouroids and respond to treatment.
O087 Potential diagnostic biomarkers for congenital vascular malformations
Authors: Abu-Hanna J , Pang C , Valnarov-Boulter A , Brookes J , Lim CS , Hamilton G , Tsui J
Published: November 2022

Introduction

To identify potential diagnostic serum biomarkers, particularly those pertaining to the processes of inflammation and angiogenesis in patients with congenital vascular malformations (CVM).

Methods

Isolated sera from the peripheral bloods of consented healthy controls (n = 10) and patients diagnosed as having either low-flow (LF) (n = 10) or high-flow (HF) (n = 10) CVMs. Various mediators of inflammation and angiogenesis were analysed in the sera using the Inflammation 20-Plex and Angiogenesis 18-Plex Human ProcartaPlex™ Panels. Analysis was conducted via Kruskall-Wallis test and correlated with lesion volumes and visual analogue scores for pain using the Spearman rank correlation test.

Results

Compared to healthy controls, the inflammatory mediators E-selectin, IFNa, IFNg, IL1b, IL4, IL12, IL17, MIP1a, MIP1b and TNFa were elevated in the sera of LF CVM patients, whereas only MIP1a was raised in the sera of HF CVM patients. None of the angiogenic mediators were altered in the sera of patients with LF or HF CVMs. Serum IFNa, IFNg, IL4, IL12, TNFa, VEGFA, VEGFD and syndecan correlated positively with pain scores in patients with LF CVMs, whereas only IP10 did in patients with HF CVMs. Serum Ang1 and leptin correlated negatively with lesion volumes in patients with LF or HF CVMs, respectively.

Conclusion

Serum inflammatory mediators could be used to distinguish LF from HF CVMs and their expression seemed to be associated with pain severity in patients with LF CVMs. The angiogenic mediators Ang1 and leptin were associated with lesion volumes in patients with LF or HF CVMs, respectively.

Take-home message

Serum inflammatory mediators could be used to distinguish LF from HF CVMs and their expression seemed to be associated with pain severity in patients with LF CVMs. The angiogenic mediators Ang1 and leptin were associated with lesion volumes in patients with LF or HF CVMs, respectively.
O088 Systematic review and meta-analysis of survival outcomes in T2a and T2b gallbladder cancers
Authors: Alrawashdeh W. , Kamarajah S. , Gujjuri R. , Abu Hilal M. , White S. , Pandanaboyana S.
Published: November 2022

Background

The 8th edition of AJCC TNM staging of Gallbladder cancer subdivided T2 stage into T2a and T2b based on tumour location. This meta-analysis aimed to investigate the long-term outcomes in T2a and T2b gallbladder cancers.

Methods

Literature search of Medline, Web of science, Embase and Cochrane databases was performed. Study characteristics, survival and recurrence data were extracted for meta-analysis of effect estimates and of individual patient data.

Results

Fifteen retrospective studies (2531 patients, T2a = 1332, T2b = 199) were included in the meta-analysis. Overall survival (OS) was significantly worse in patients with T2b compared to T2a tumours (HR 2.18, 95% CI 1.67–2.86, p < 0.0001). Meta-analysis of individual patient data (n = 629) showed similar results (HR 1.92, 95% CI 1.43–2.58, p < 0.00001). Patients with T2b tumours had higher risk of recurrence compared to T2a (OR 3.19, 95% CI 1.40–7.28, p = 0.006) and were more likely to receive adjuvant chemotherapy (OR 1.76, 95% CI 1.12–2.84, p 0.014). Liver resection improved OS in T2b tumours (HR 2.99, CI 1.73–5.16, p < 0.0001).

Conclusion

T2b gallbladder tumours have worse overall survival and increase risk of recurrence compared to T2a. Liver resection appears to improve OS in patients with T2b tumours. However, high quality multicentre data is required to confirm these results.

Take-home message

T2b gallbladder tumours have worse overall survival and increase risk of recurrence compared to T2a. Liver resection appears to improve OS in patients with T2b tumours. However, high quality multicentre data is required to confirm these results.
O089 Relationship of metformin with the risk of pancreatic cancer in patients with diabetes and/or chronic pancreatitis: a systematic review
Authors: Mascarenhas A , Adiamah A , Lobo DN
Published: November 2022

Introduction

Metformin is the first-line treatment in patients with Type 2 diabetes. However, controversy exists regarding its role in reducing the risk of pancreatic cancer or improving pancreatic cancer survival in patients with Type 2 diabetes or chronic pancreatitis. This systematic review aimed to define the risk of pancreatic cancer and survival from pancreatic cancer in patients with diabetes or chronic pancreatitis receiving metformin.

Methods

Systematic searches of Medline and Cochrane Library databases were undertaken to identify studies reporting on the use of metformin and its impact on pancreatic cancer risk and/or survival in patients with diabetes or chronic pancreatitis.

Results

Thirty studies, reporting on a total of 5,969,712 patients (1,362,308 with diabetes or chronic pancreatitis, and 4,597,095 controls), were included. Eleven studies assessed the risk of developing pancreatic cancer. Of these, six found a significant reduction in the risk of developing pancreatic cancer in those taking metformin, whereas five studies found no such reduction in pancreatic cancer risk. Another 19 studies evaluated the impact of metformin on pancreatic cancer survival. Twelve of these found evidence of benefit in those receiving metformin, whereas seven found no survival benefit. Formal pooling could not be undertaken due to high statistical and clinical heterogeneity.

Conclusion

The relationship between the use of metformin and the incidence of pancreatic cancer is complex and multifactorial. However, the currently available evidence is not sufficient for definitive conclusions on this relationship.

Take-home message

Current evidence is not robust enough to recommend the use metformin as prophylaxis for pancreatic cancer or to improve survival in patients with pancreatic cancer.
O090 The Sweet approach to oesophagectomy is still a valid surgical approach seldom used in the UK
Authors: Ammar A , Paul M , El-Sharkawy A , Leeder P , Bohra A , Awad S , Iftikhar S
Published: November 2022

Introduction

The left thoracophrenotomy approach to oesophagectomy or Sweet Oesophagectomy (SO) for oesophageal cancer is performed by many centres worldwide but seldom used in UK, owing to concerns over extent of lymphadenectomy compared with Ivor-Lewis oesophagectomy (ILO) approach. This study aims to compare oncological and clinical outcomes following the Sweet approach with ILO.

Methods

A retrospective, single centre study was conducted, analysing all patient data following the SO approach and ILO for oesophageal cancer between August 2012 - March 2021.

Results

The total number who underwent the Sweet (SO) operation and ILO was 72 and 197 patients respectively.91.7% vs 80.2%, p=0.071 were distal oesophageal tumours. Median lymph node count were 22 and 23 respectively, p=0.980. The Sweet was associated with 69.4% circumferential, 94.4% proximal and 95.8% distal R0 resections compared with 72.6% (p=0.365, 98%(p=0.132) and 96%(p=0.330) with ILO resection, respectively. Median operative time was 169 vs. 301 minutes for Sweet and ILO respectively, p<0.001. The overall complication rate was 29.2% with the Sweet and 45.7% with ILO, p=0.015, including, Anastomotic leaks 0 vs. 11, p=0.041 And return to theatre 1 vs. 22, p=0.04. The 30, 90 day and 5-year survival was 100% vs. 99%(p=0.391), 98.6% vs. 95.9% (p=0.281) & 51.4% vs. 50.3% (p=0.869), respectively.

Conclusion

The Sweet procedure was associated with comparable oncological efficacy and survival to ILO. Furthermore, was associated with significantly shorter operative time and lower complication rates, therefore should be considered in selected cases.

Take-home message

Left thoracotomy oesophagectomy remains an appropriate option with significantly better results in our centre, in the management of lower oesophageal and junctional carcinoma as compared to ILO. Having a reduced hospital stay and operative time may be more favourable in more frail patients with distal and junctional oesophageal tumours.
O091 Social deprivation and malignant progression of anal intraepithelial neoplasia
Authors: Hinchcliffe Z , Soliman F , Hargest R
Published: November 2022

Introduction

Social deprivation is known to be a risk factor for cervical cancer but its influence on progression rate to invasive cancer is less clear. This study aimed to investigate whether deprivation was a risk factor for high grade anal intra-epithelial neoplasia (AINIII) progression to anal squamous cell carcinoma (ASCC).

Methods

Retrospective analysis of AINIII patients in Southeast Wales between 2000–2021. Deprivation was calculated from postcodes at time of referral, divided into five quintiles (Welsh Index of Multiple Deprivation 2019). Welsh Clinical Portal and Cancer Network Information System Cymru (CaNISC) were utilised to collect patient demographics, histopathology and clinical outcomes.

Results

Eighty-six AINIII patients were identified. Twenty-nine presented with synchronous ASCC and AINIII. Thirteen progressed to cancer (median 23 months). The proportion of patients in each deprivation quintile was calculated. The association between deprivation and incidence of ASCC at presentation (p=0.93) and AIN transformation to ASCC (p=0.65) were not statistically significant (chi-square analysis).

Conclusion

No correlation between presentation of anal ASCC or AINIII progression and social deprivation was observed. Due to small sample size, multicentre research is required to investigate this further.

Take-home message

Social deprivation was not observed to be a risk factor for anal Intra-epithelial Neoplasia III or anal cancer in our cohort. However, further research across a larger sample size is required to investigate this association further.
O093 The adrenal incidentaloma clinic: a novel and streamlined approach
Authors: Iskandar M , Chauhan V , Tunstall L , Alasttal S , Fouad M , Chadwick D , Christakis I
Published: November 2022

Introduction

An incidental adrenal nodule is present in 1–3% of abdominal cross-sectional imaging and pose a diagnostic dilemma for the investigating clinician. Adrenal nodules can be functional or pose a cancer risk, hence a complete adrenal hormone profile investigation is necessary.

Methods

We piloted a streamlined clinic within the endocrine surgery department for assessing adrenal incidentalomas by trained surgical care practitioners. Data was collected retrospectively for patients reviewed from March 2020 to September 2021 to evaluate its efficacy and the completion of investigations.

Results

98 new patients were seen, with an average age of 64.97 (±13.91) years. The mean time from referral to review was 37.61 (±26.07) days. The mean nodule size was 21.74 (±9.93) mm (range: 6.00–73.00 mm) and were most commonly identified on CT virtual colonoscopy (28.6%), CT abdomen and pelvis (20.4%) and Trauma CT (10.2%), with over two-thirds of referrals from colorectal services (38.9%) and Emergency Medicine (29.5%). 82.7% of patients had metanephrines tested, 79.6% for aldosterone-renin ratio and 75.5% for overnight dexamethasone suppression test following clinic attendance. 8.6% of patients had raised metanephrines, with 25.6% for aldosterone-renin ratio and 37.8% for overnight dexamethasone suppression test. 27.8% were referred on for further assessment with an adrenal CT. Three patients were operated on, one for phaeochromocytoma and two patients for metastases.

Conclusion

Preliminary results suggest this clinic provides efficient services with good completion of investigations and follow-up. It offers clinicians unfamiliar with or unable to organise adrenal investigations, a dedicated clinic, to ensure appropriate clinical assessments.

Take-home message

This dedicated incidentaloma clinic contributes to the effective use of resources in doing hormonal profiling for patients and identification of patients at risk of functional and malignant adrenal disease.
O094 Novel technique and cohort study: Stoppa approach to sciatic notch clearance in locally advanced / recurrent pelvic cancer pelvic cancer
Authors: Sahid S , Daurka J , Gibbs R , Murphy J
Published: November 2022

Introduction

Locally advanced / recurrent pelvic cancers (LARC) extending into the greater sciatic notch represent a significant clinical challenge. Conventional surgical resection is associated with high rates of R1/2 resection, while locoregional oncological treatments often fail to control the disease. In this study we present the first report of a modified Stoppa approach that facilitates en bloc excision of pelvic sidewall structures with LARC.

Methods

This is a retrospective review of patients who underwent surgery for LARC with the novel Stoppa approach between 2016 and 2020 in our centre.

Result

7 patients (6 female and 1 male) were identified from the institutional database with Median age of 66 (37–74). Three separate tumour types were included in the cohort: rectal adenocarcinoma - 4 (57%), anal squamous cell carcinoma - 2 (29%), and prostate adenocarcinoma - 1 (14%). 3 (42%) patients developed Clavien Dindo Class III complications (2 returned to theatre for minor flap revisions; 1 pre-sacral collection required radiological drainage). All patients lost active ipsilateral foot dorsiflexion due to planned nerve root transection. Median hospital stay was 46 days (17–114). All resections were R0.

Conclusion

This is the first report of a novel Stoppa approach for en bloc pelvic sidewall excision. The presented pathological resection results are promising; however, this procedure is associated with significant morbidity. Future studies will be necessary to confirm the presented oncological results and determine if the associated morbidity can be decreased.

Take-home message

Modified Stoppa technique is feasible to achieve Sciatic Notch tumour clearance in primary or recurrent locally advanced pelvic cancer. Further research needed to assess long term oncological outcome and reduce post operative morbidity.
O095 Cell-based therapies in surgery: a systematic review of the yield and composition of freshly isolated cells obtained from point-of-care devices which mechanically dissociate lipoaspirate
Authors: Liu P , Gurung B , Sochart D , Kader D , Asopa V
Published: November 2022

Introduction

Cell-based therapies using lipoaspirate are gaining popularity within surgical fields due to their hypothesised regenerative potential. Several point-of-care lipoaspirate-processing devices have become available to isolate cells for therapeutic use, with published evidence reporting their clinical relevance. However, few studies have analysed the composition of their minimally manipulated cellular products, information that is vital to understand the mechanisms by which these therapies may be efficacious. This review aimed to identify devices using mechanical-only processing of lipoaspirate, their cell yields, viability, phenotype and where available clinical outcomes.

Methods

MEDLINE, Embase and PubMed databases were systematically searched on 01/09/21 using relevant keywords. PRISMA guidelines were followed (PROSPERO#CRD42021282041), and level of evidence was assessed using the Oxford Centre for Evidence-Based Medicine guidelines. Information was extracted and analysed to summarise the cellular composition derived from these devices and their clinical outcomes.

Results

2895 studies were screened and a total of 15 articles (11=Level 5 evidence) fulfilled the inclusion criteria. Overall, 13 devices were identified. All the studies reported cell yield for their devices (range 0.005–21×106). 10 reported viability (range 60–98%), 11 performed immuno-phenotypic analysis of the cell-subtypes and 4 investigated clinical outcomes of their cellular products. Only 2 studies reported all four parameters.

Conclusion

Although many devices are available to mechanically process lipoaspirate, few have published peer-reviewed literature of their products’ composition. Significant heterogeneity in the reporting of these studies makes it difficult to summarise their clinical potential. This review is unable to make any recommendations on the clinical use of these devices.

Take-home message

Many point-of-care devices have become available to mechanically process lipoaspirate to form a cellular product for therapeutic use in surgery. However, few have publications on their products’ composition which is information required to understand the mechanisms by which these therapies may be efficacious.
O096 Does boron bioactive glass have a role in bone regeneration?
Authors: Awad L , Vaporidu N , Rezaei A , Jell G
Published: November 2022

Introduction

Bioactive glasses (BGs) provide an alternative to allogenic bone grafts. Various ions can be incorporated into the BGs structure to further influence regenerative or antimicrobial properties. Boron has recently been purposed as element that can be incorporated into BGs to promote desirable cellular regenerative response. This study aims to systematically review literature to determine the level of evidence that boron bioactive glasses (BBGs) and boron can promote desirable bone regenerative responses both in vitro and in vivo.

Methods

A systematic review of Web of Science was conducted in accordance with PRISMA guidelines. Data collected included bone cell behavioural analysis in response to boron or BBG compared to controls. Material properties of BBG (mechanical properties, degradation rate) compared to BG were compared.

Results

A total of 105 articles were included; 98 regarding BBG, and 12 articles studying the effect of boron. A higher biodegradation rate was observed in BBG compared with silicate-based BGs. BBGs have a lower compressive strength and increased fragility, as the percentage of B203 increases. 16 articles demonstrated a positive correlation with BBG and expression of OCN, VEGF, osteopontin, and RUNX2. Overall, metabolic activity of cells up to 14 days was lower in comparison to media and silicate BG.

Conclusion

BBGs have gained increased attention in the literature but the lack of heterogeneity and paucity of data does not provide convincing evidence of the effect of boron on bone regeneration and indicates the need for further quantitative research with a standardised approach to assessment.

Take-home message

Bioactive glasses can promote regeneration of bone, however the lack of heterogeneity and paucity of data regarding boron bioactive glass indicate the need for further quantitative research and standardised approach to assessment.
O097 Developing a core outcome set for hand fractures and joint injuries in adults
Authors: Deshmukh SR , Leighton P , Montgomery AA , Kirkham J , Trickett R , Jerosch-Herold C , Rodrigues JN , Griffin X , Costa ML , Karantana A
Published: November 2022

Introduction

A core outcome set is a baseline set of agreed upon outcomes to be used in all future clinical research on a given health topic. We aimed to develop a core outcome set for hand fractures and joint injuries in adults.

Methods

We synthesised the outputs of our prior systematic review of treatment outcomes and qualitative work exploring the patient perspective to develop a longlist of outcome domains. This longlist entered a consensus prioritisation process. An international three-round Delphi survey involving patients, hand therapists and surgeons prioritised domains which were then considered in a subsequent virtual international consensus meeting involving key stakeholder groups. Using a process of discussion and prioritisation steps with pre-determined consensus criteria, the panel agreed upon a final core outcome set.

Results

In the Delphi survey 41 outcome domains were rated. 144/152 participants (>94%) completed all three rounds (54 patients, 55 surgeons, 35 hand therapists). 20 domains reached consensus as very important. The final consensus meeting had 27 participants (12 patients, seven surgeons, six hand therapists, a health economist and a trial manager). After iterative prioritisation steps, a final vote selected seven outcome domains for inclusion in the core outcome set.

Conclusion

Through consensus prioritisation steps we developed a final set of seven core outcome domains. These cover areas such as functional tasks, patient comfort, abstract/physiological function and patient satisfaction. They are recommended as the baseline domains to be measured in all future clinical research on hand fractures and joint injuries in adults.

Take-home message

A core outcome domain set has been developed for hand fractures and joint injuries in adults, based on agreement by the key stakeholder groups. All future clinical research on these injuries should measure these domains as a baseline to improve consistency and comparability of the field of research.
O101 Increased contractile activity through electrical stimulation attenuates postoperative loss of muscle mass and function, even in the presence of inadequate nutrition
Authors: Hardy E , Hatt J , Doleman B , Smart T , Phillips B , Lund J
Published: November 2022

Introduction

Significant muscle atrophy occurs after major abdominal surgery. Lack of physical activity and protein intake may play a significant role. This study assesses the efficacy of neuromuscular electrical stimulation (NMES) in attenuating loss of muscle mass and function following open colorectal resection.

Methods

Fifteen patients were recruited, and their lower limbs randomised to control (CON) or NMES (STIM). Vastus Lateralis (VL) cross sectional area (CSA), muscle thickness (MT) and knee extensor strength (KES) were measured preoperatively and repeated on postoperative day (POD) 5. Dietary intake was recorded, and nutritional intake calculated. Fifteen minutes of NMES was applied to the quadriceps of the STIM leg twice a day on POD 1–4. All outcomes were analysed using linear mixed model approaches. The study was approved by the NHS REC (ref 20/EM/069).

Results

NMES significantly reduced the loss of CSA (mean difference (MD) 1.18, 95%CI: 0.75–1.61, p<0.001), MT (MD 0.12, 95%CI: 0.04–0.2, p=0.001) and KES (MD 4.48, 95%CI: 0.00–8.97, p=0.03). Total energy and protein intakes over POD1 - 4 were 42.6% (± 19.7) and 21.1% (± 11.4) of the ESPEN recommended daily amount for perioperative patients. No adverse events occurred, and patients reported that NMES caused minimal or no discomfort.

Conclusion

NMES has been demonstrated to reduce loss of muscle mass and function following major abdominal surgery and may be an important tool in aiding recovery to normal functional state.

Further studies should establish the efficacy of bilateral whole-leg NMES for improving patient centred outcomes.

Take-home message

Loss of muscle mass and function after major abdominal surgery causes significant morbidity. Neuromuscular electrical stimulation reduces this muscle loss and should be investigated further as a potential therapy.
O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity?
Authors: Patel P , Thomas R , Hamady M , Hague J , Raja J , Tan T , Bloom S , Richards T , Weiss C , Prechtl C , Smith C , Thiagarajah S , Fiorentino F , Markakis H , Ahmed AR
Published: November 2022

Introduction

Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.

Methods

9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.

Results

N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.

Conclusion

LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.

Take-home message

Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.
O103 The relationship between routine pre-operative clinicopathological factors and post-operative infective complications in patients undergoing elective potentially curative colon cancer resection
Authors: Cheong CM , Golder A , Horgan P , Roxburgh C , McMillan D
Published: November 2022

Introduction

Post-operative complications, in particular infective complications, following elective colon cancer resection remain common. The present cohort study was designed to determine the influence of routinely reported clinicopathological factors on post-operative infective complications in a large regional cohort undergoing potentially curative colon cancer.

Methods

Patients who underwent elective potentially curative colon cancer resection between January 2011 and December 2014 were assessed for post-operative complications. Clinicopathological data were recorded in a prospectively maintained database. A multivariate binary logistic regression model was used to identify independent risk factors for infective complications.

Results

A total of 1887 patients were included with 29% of patients developing post-operative infective complications (POI). Multivariate analysis showed that factors associated for both POI complications and surgical site infections (SSI) were higher body mass index (BMI) (POI OR 1.29, 95% CI 1.15–1.46, p<0.001 and SSI OR 1.4, 95% CI 1.23–1.60, p<0.001), diabetes (POI OR 1.45, 95% CI 1.06–1.99, p=0.022 and SSI OR 1.58, 95% 1.12–2.22, p=0.009) and open or laparoscopic converted to open surgical approach (POI OR 0.66, 95% CI 0.52–0.84, p=0.001 and SSI OR 0.70, 95% CI 0.53–0.93, p=0.012). While 30-day mortality was associated with older age, high ASA grade and pre-operative systematic inflammatory grade.

Conclusion

Elevated BMI and diabetes were independently associated with infective complications and surgical site infections. Therefore, the BMI and diabetes status should be routinely determined in patients undergoing elective surgery for colon cancer.

Take-home message

Body mass index and diabetes status should be actively determined prior to elective surgical intervention to allow for risk stratification and pre-operative optimisations.