bluuebunny/crossref_metadata_2025 huggingface dataset:
A O04 Prevalence and risk factors for malignant nodal involvement in early oesophago-gastric cancer: Initial results from the CONGRESS study (endosCopic resectiON, esophaGectomy or gastrectomy foR Early oeSophagogastric cancerS)
Authors: Pucher Philip , Underwood Tim , Kamarajah Sivesh , Blencowe Natalie , Griffiths Ewen , Evans Richard , Markar Sheraz , Bhandari Pradeep , Trudgill Nigel , Crosby Tom , Gossage James
Published: November 2023

Background

Controversy remains surrounding the optimal management of patients with T1N0 early oesophago-gastric (OG) cancer. Current guidelines recommend consideration of radical surgery for T1b disease because of the greater risk of nodal metastasis. However, data to accurately predict risk for individual patients is sparse; individual units may see only low numbers of patients with early stage disease. The endosCopic resectiON, esophaGectomy or gastrectomy foR Early oeSophagogastric cancerS (CONGRESS) study was a retrospective multinational study which aimed to characterise the impact of different management strategies, including endoscopic resection (ER) and radical surgery, for early OG cancer on a large scale.

Methods

An international multicentre retrospective study was performed. Inclusion criteria were all patients diagnosed with T1N0 OG cancer from 2015 to 2022. Led by local and regional collaborators, centralised anonymised data capture was used to record diagnostic, demographic, treatment, and outcome data. Histopathological outcomes for surgical resection specimens were compared to pre-operative staging and diagnostic data. Statistical analysis was performed to assess the association between patient demographic and histological data, and presence of malignant nodal disease.

Results

A total of 1,509 patients from 26 centres were recorded, with a median 33 months (range 0-194) follow-up from diagnosis. Initial T stage at diagnosis was T0 266/1509 (17.6%), unspecified T1 375/1509 (24.9%), T1a 319/1509 (21.1%), T1b 204/1509 (13.5%), TX 313/1509 (20.7%). Of 436 patients who underwent surgical resection, the risk of nodal metastasis for each clinically or endoscopically staged depth of invasion was T0: 5/31 (16.1%), unspecified T1: 37/193 (19.2%), T1a: 7/73 (9.6%) T1b: 21/137 (15.3%). No histological or patient factors were significantly associated with presence of positive nodes in the surgical resection specimen.

Conclusions

The risk of nodal metastases in this real-world contemporary dataset suggests a higher rate of nodal metastasis than reported in some series. Tumour depth alone is a poor predictor of nodal positivity. Further work is required to determine which patients might benefit from an organ-preserving versus resective treatment approach.
A O06 Impact of complications on survival and postoperative recovery using Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial
Authors: Triemstra Lianne , de Jongh Cas , Tedone Fabrizio , Brosens Lodewijk Lodewijk A A , Luyer Misha , Stoot Jan , Lagarde Sjoerd , van Hillegersberg Richard , Ruurda Jelle
Published: November 2023

Background

Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery.

Methods

The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications, and infectious, gastrointestinal, pulmonary, and cardiovascular complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman’s rho-test, and compared with standard Fisher’s z-transformation.

Results

Between 2015-2018, 211 patients underwent laparoscopic (n=106) or open (n=105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p=0.755) and subgroups of complications (p>0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs=0.646 versus rs=0.628; p=0.001, clinically irrelevant), and reoperations (rs=0.590 versus rs=0.599; p=0.070), and weak correlations for ICU-stay (rs=0.446 versus rs=0.440; p=0.189).

Conclusions

The CCI is a composite scoring system based on the CDC, and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, after abdominal surgery other than gastrectomy. Implementation of CCI had no clinically relevant benefit and produced additional workload compared to CDC for assessing complication burden. Therefore, the use of CCI alongside the CDC after gastric cancer surgery is not recommended.
BS O03 Awareness of Obesity and Morbid Obesity amongst General Population: a pilot, cross-sectional survey study
Authors: Bandyopadhyay Samik , Patel Agastya , Ganguly Guruprasad , Iqbal Affan
Published: November 2023

Background

There has been a serious concern about Obesity and obesity related diseases - there has been co-ordinated efforts to get the message to the general population to encourage them to be more active in self-care. This study was an attempt to assess the prevalent awareness in the general population to understand whether the ongoing efforts have achieved the desired goals.

Methods

The study was coordinated with the assistance of a General practitioner in North West England. Patients attending the GP Surgery physically were requested to fill up a small questionnaire without resorting to any online resources. Patient below sixteen years of age, unwilling patients or patients with dementia were excluded from the study. The questions were focussed on defining obesity and morbid obesity, the different obesity related illnesses and the possible options available to an obese patient in need of treatment. The study was conducted over a period of two months and responses available from 226 patients who participated were analysed.

Results

73% of responders were aware of obesity as a disease entity but less than 60% could differentiate between obesity and morbid obesity. However, less than 30% were aware of the BMI value beyond which a person could be termed obese. Significantly, less than 1% could pick up four obesity associated diseases.

Conclusions

It appears that more focussed population based primary prevention is necessary to stem the obesity epidemic. Awareness appears to be patch and in a few groups, lacking. A larger population based study with subgroup analysis based on geographical location, age and ethnicity may be important to assess the situation in a greater detail.
BS O04 Can virtual reality exercise games improve compliance with preoperative prescriptive exercise programs in patients awaiting bariatric surgery?
Authors: Aburrous Mohamed , Adwan Hussamuddin , Tam Adam , Gendia Ahmed , Cota Allwyn , Finlay Ian , Clarke Michael , Clark James
Published: November 2023

Background

Despite the recognised benefits of increased activity prior to any surgery, non-compliance rate with prescribed exercise regimens is perceived to be higher amongst patients with obesity. Virtual-reality is becoming more recognised as an adjunctive tool within the healthcare setting. In this setting the platform enables exercise games to be played and enjoyed in the comfort of the patient’s own home, either sitting or standing depending on physical disability. The study aims to identify whether VR exercise games could be considered part of the pre-operative exercise program in patients awaiting bariatric surgery and the effects of this technology on compliance.

Methods

A pilot study using block randomisation, patients with obesity planned for laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between December 2020 and December 2023 were recruited to a 6-week pre-operative regular exercise (REG) programme of either regular walking activity (RWA) or exercise using Virtual Reality device (VRX). Patients who later decided not to follow the exercise protocol were included as control (NEG). Patients with epilepsy, uncontrolled arrhythmias, heart failure or those unable to use VR systems were excluded. Pre- and post-trial demographic and progress data and follow up survey using the New Zealand Physical Activity Questionnaire were collected.

Results

43 patients were recruited, 46.4kg/m2 mean referral BMI (33.8 – 65.6, SD 6.4) and 84% female. Exercise non-compliance was comparable between RWA and VRX groups (40 vs 43% respectively). 56% of NEG had their operation during short day light season (44% of REG). NEG group reported higher rate of chronic pain, poor motivation, and higher incidents of changes to surgery date (33, 33 and 22% respectively vs. none in REG). While weight loss achieved in REG prior to the operation was higher than in NEG, there was no significant difference in weight loss between the groups at 3 months follow up.

Conclusions

While the role of prehabilitation exercise prior to major elective surgery is well documented, the search for the ideal approach to achieve this is still ongoing. This pilot study demonstrates the limitations certain chronic conditions in patients with obesity have on the success of a pre-operative exercise programme. While more data is needed, it is important to bear these limitations in mind when recruiting patients to any exercise programme. The compliance rate remains unfavourable despite the use of VR technology.
BS O09 Bariatric Medical Tourism - a false economy. A case series of complications and the impact on the NHS
Authors: Beynon Victoria , Iosif Evangelia , Gaston Michaela , Hao Bo , Kerans George , Mohamed Omnia , Maheswaran Ian , Belgaumkar Ajay , Carswell Kirstin
Published: November 2023

Background

Increasing numbers of patients from the United Kingdom are going abroad for treatment, in order to avoid lengthy NHS waiting lists for primary weight loss surgery and to circumvent restrictions on cosmetic operations, post-bariatric surgery. News media often report individual patient stories about post-operative complications. Patients are increasingly accessing NHS emergency services when these occur. The aim of this study was to evaluate the impact on both patients and the NHS from treatment of complications associated with Bariatric medical tourism.

Methods

A retrospective case study was performed between July 2022-June 2023 at East Surrey Hospital, the nearest hospital to London Gatwick Airport. The study included all patients who presented as an emergency with complications associated with bariatric or post-bariatric procedures performed outside of the UK. Data was collected via electronic patient records, including patient demographics, BMI, original operation, complications, investigations, treatment and length of stay. A cost analysis was performed for each patient’s ‘in-patient’ stay using the ‘NHS Payment Scheme (2023/24)’. Further cost analysis of ongoing community intervention was not performed.

Results

A total of 15 patients were identified in this time frame. 13 (86.6%) were female with mean age 40 years (range 27-54). Mean BMI was 35 (range 29-44). The most common original operation was post-bariatric Abdominoplasty (46.6%), followed by Laparoscopic Sleeve Gastrectomy (26.6%). 14 (93.3%) patients had their original operation performed in Turkey. Time to emergency presentation ranged from 7-365 days. 66.7% of complications were graded Clavien Dindo score 3 or above. 8 (53.3%) patients required multiple admissions. The average length of stay was 7.5 days (range 1-37). The cost per patient to the NHS averaged at £6857.14 (£600-£28,625).

Conclusions

This study shows that medical tourism has a significant impact on NHS services, costing over £100,000 in our hospital alone, in one year. Common factors in this patient cohort included poor pre-operative optimisation, continued smoking, vitamin and mineral deficiencies and delayed presentation once complications occurred. Given that medical tourism is increasing, public health education about the risks should increase. Such efforts may mitigate the cost impact on the NHS. It is time for a national registry for international complications and a UK governance strategy is implemented.
HPB O03 ERCPs and Biliary Stenting for Ductal Stone Disease: A Call for a National Database
Authors: Curwen Oliver , Hwang Reif , Gower David , Nehra Dhiren
Published: November 2023

Background

According to the European Society of Gastrointestinal Endoscopy, in the context of complicated biliary stone disease, plastic stenting of the biliary tree via endoscopic retrograde cholangiopancreatography (ERCP) temporarily provides drainage of a blocked or infected biliary system. However, there is high mortality and morbidity associated with long-term endoprostheses; cholangitis as one of the main complications. Therefore, plastic stenting should only be used for a period of up to 6 months, according to latest guidelines. Our aim was to compare Trust practice with international recommendations, identifying potential causes for prolonged stent placement in patients with choledocholithiasis, and to discuss possible solutions.

Methods

Patients who underwent an ERCP across a 3-year period from NHS secure server records were identified, with further analysis of patients undergoing plastic biliary stent insertion.

Results

Of the 1118 ERCPs performed, 281 underwent plastic stenting for choledocholithiasis. Some patients were not suitable for cholecystectomy, so stents were accepted as the ceiling of care. 29 had stents in situ for over 6 months, while waiting for surgery. Of the 75 who had proceeded to cholecystectomy, 57 subsequently had stents removed in the trust. 18 still had plastic stents in situ. 5 had stents removed elsewhere, one of whom developed cholangitis and sepsis, requiring removal of the infected stent at a tertiary centre. Two patients were no longer fit for removal, and two had spontaneously passed their stents.

Conclusions

Retained biliary stents is not a rarity. There are many factors leading to delays, including long waiting lists for surgery, lack of requests to the endoscopy department and patient choice. Extrapolation of this single-trust audit would suggest that many sites are not meeting international guidelines for the duration of indwelling plastic stents. We suggest the implementation of a national database to monitor all patients with biliary endoprostheses to reduce morbidity associated with retained stents. We also recommend that incidents where harm is caused by plastic stents remaining in situ for greater than six months be treated as a Never Event.
HPB O05 Targeting the host in Pancreatic Cancer: A Novel Combination Therapeutic from Bench to Bedside
Authors: Jones Keaton , Russell Shannon , O’Neill Eric
Published: November 2023

Background

We have designed a novel therapeutic approach to improve immunity whilst simultaneously reversing immune suppression in pancreatic cancer. Radiotherapy can cause the release of tumour specific antigens from lethally irradiated cells, as well as the generation of neopeptides resulting from novel mutations. In addition, Eganelisib, a small molecule inhibitor that blocks the pathway responsible for the phenotypic switch towards a suppressive phenotype in myeloid cells (PI3K-gamma) promotes antitumour immunity. We hypothesise that combined treatment will improve anti-tumour immunity in pancreatic cancer.

Methods

To generate primary pancreatic tumours, (KPC) pancreatic cancer cells were injected directly into the pancreas. Radiotherapy was delivered in 3 fractions of 4Gy via CT guidance. PI3K-gamma inhibition was carried out using TG100-115. For immune phenotyping, tumours were analysed by flow cytometry, multiplex immunohistochemistry and RNA sequencing. Combination treatmenthas been applied to primary human tissue slices (Avatars) in dynamic perfusion culture.

Results

In a preclinical model of pancreatic cancer, combined treatment with radiotherapy and Eganelisib resulted in significantly increased overall survival. Analysis of the tumour immune microenvironment in this group revealed decreased numbers of suppressive myeloid cells and increased numbers of cytotoxic CD8 T cells. RNA sequencing data demonstrated that pathways associated with innate inflammation and adaptive antitumor immunity were significantly elevated.

Conclusions

We have used our preclinical data to drive the translation of this novel therapeutic combination. Preclinical data has provided robust evidence that this combination approach results in effective antitumour immunity that may render tumours sensitive to immune checkpoint therapy. We are currently designing a Phase I clinical trial combining MR-LINAC guided radiotherapy with Eganelisib for patients with locally advanced pancreatic cancer.
HPB O06 Strategy, evolution and outcomes of a ‘unit-wide’ approach to robotic surgical training – evaluation of the experience in a high-volume tertiary hepatopancreaticobiliary unit
Authors: Pencavel Tim , Worthington Tim , Riga Angela , Kumar Rajesh , Lahiri Rajiv
Published: November 2023

Background

Robotic surgery has been a 'slow-burning' technology in HPB Surgery in the UK, partly due to availability of robotic systems due to more rapid adoption in other subspecialties. It has also been seen as the preserve of one or two early adopters, both within units and more widely. In this study we evaluate an alternative approach to starting a robotic programme, with an a priori intent to train multiple members of the same unit following a structured process and continuous real-time outcome evaluation.

Methods

The training programme was structured in line with the Intuitive console surgeon training pathway consisting of online modules, simulation training and laboratory courses. Case acquisition was in line with the suggested escalation of difficulty laid out in the paper by Farrugia et al (J Robotic Surg 2022). Surgeons trained in pairs, with the order determined by robotic availability and previous minimally-invasive HPB experience. Regular robotic access was secured by agreement with other robotic specialties. A prospective database of cases was maintained and regularly interrogated to evaluate outcomes at a unit and surgeon level.

Results

245 cases were performed in 18 months. Case acquisition rate was similar for all surgeons. Unit volume slowed from a peak of 21 cases/month until acquisition of a 3rd Xi system, facilitating 3 regular HPB robotic lists/week. Following this both number and complexity of cases increased. All surgeons experienced a decrease in total numbers of complex cases in the first month, which had returned to baseline at 6 months (mean 9.25 v 3.5, p<0.05). Overall length of stay, HDU stay and conversion rates were lower than surgeon- and case-matched historical data, with no significant increase in complication rates.

Conclusions

The introduction of a unit-wide robotic programme is feasible and results in better robotic utilisation. Case acquisition can be maintained for all surgeons. A possible further benefit is a greater acceptance of the need to share the caseload for open and laparoscopic cases during the learning curve. Robotic access is key to successful implementation and must be assessed before the programme begins. Outcomes at a unit- and surgeon- level can be maintained or improved regardless of the career stage of the surgeon prior to beginning robotics.
HPB O07 Neoadjuvant therapy response and survival in borderline resectable and locally-advanced pancreatic ductal adenocarcinoma; the largest UK case series
Authors: Khaled Yazan , Suresh Nikhil , Tetley Heather , Young Alistair , Pine James , Pathak Samir , Smith Andrew
Published: November 2023

Background

Neoadjuvant chemo/radiotherapy (NAT) is the treatment of choice for borderline resectable/ locally-advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). Current preoperative imaging modalities (CT/MRI) and biomarkers lack sensitivity to predict response following NAT. The aim of this study was to evaluate preoperative PETCT and CA19-9 in predicting NAT response and survival.

Methods

A retrospective analysis of consecutive patients who underwent NAT for BR/LA PDAC between January 2013 and January 2023 was performed. Clinicopathological characteristics, treatment, and outcome were analysed. Pre- and post-NAT CA 19-9 and PETCT findings were correlated with resectability and pathological response. Overall survival (OS) and disease-free survival (DFS) comparisons were performed using log-rank model and Kaplan–Meier analysis.

Results

Tumour response following completion of NAT was evaluated in 87 (BR, n=58 and LA, n=29) patients with a median age of 73.3 years (47-87 years). FOLFIRINOX alone (93%, n=81) was mostly used as chemotherapy versus gemcitabine/nab-paclitaxel (7%). Post NAT, 51% of patients had biochemical response (CA19-9>50% decrease) and 48% had metabolic response on PETCT. Overall, 31(35%) individuals (BR, n=27 and LA, n=4) underwent complete resection with 81% achieving R0 status. After univariate analysis, pre-operative PETCT metabolic response (HR, 2.1; 95% CI, 1-4.3) was the only pre-operative predictor of resectability and correlated significantly with pathological response (P<0.003). In multivariate analysis, pre-operative metabolic response was the best performing predictor for resectability (P<0.001), pathological response (P<0.003), DFS (HR, 1.34; 95% CI, 1.3-1.9) and OS (HR, 1.45; 95% CI, 1.2-1.8). NAT patients had a median OS of 19 months, improving to 36 months for patients receiving NAT followed by curative surgery (HR 0.3; 95% CI, 0.1-0.56. P < .0001).

Conclusions

PETCT metabolic response appears to be highly predictive of resectability, pathological response and survival following NAT for BR/LA PDAC. An adequate staging of PDAC and re-assessment of the tumour after neoadjuvant therapy using PETCT would allow the multidisciplinary team to choose the most appropriate treatment for the patient.
OGBN O06 Enhancing Surgical Decision-Making with High-Resolution Manometry and Distal Contractile Integral in Preoperative Assessment for Magnetic Sphincter Augmentation (LINX)
Authors: Miah Ismail , Wong Terry , Gossage James , Zeki Sebastian , Jafari Jafar
Published: November 2023

Background

Preoperative assessment for magnetic sphincter augmentation (MSA) (LINX) involves evaluating the Mean Distal Amplitude (MDA) on conventional manometry to assess the patient suitability and risk of post-operative dysphagia. In the last decade high-resolution manometry (HRM) has superseded conventional manometry owing to obtaining more clinical information on the oesophageal motility, including the Distal Contractile Integral (DCI) that incorporates contractile amplitude, duration and contractility propagation length within the oesophageal body. The purpose of this study is to translate the MDA to modern DCI as preoperative marker to MSA.

Methods

This retrospective study includes patients referred to oesophageal laboratory at Guy’s Hospital between March and May 2023. Patients underwent HRM with ten 5ml water swallows that provided manometric information to compute mean DCI and MDA (MDA waveforms at 11cm, 7cm and 3cm above the GOJ were used). Statistical analysis investigated the relationship between MDA and mean DCI using Pearson correlation, Student t-test, ROC curve analysis and relevant metrics assess the cut-off threshold accuracy and reliability in classifying normal MDA.

Results

270 patients were included in the study (female:male=190:80 males, mean age 52.1 years). There was strong direct correlation between MDA and mean DCI (r=0.71, p<0.0001) (Figure 1). Patients with normal MDA had a significantly higher mean DCI compared with weak MDA at 11cm (601mmHgscm vs 167.15mmHgscm, p<0.0001) 7cm (286.4mmHgscm vs 741mmHgscm, p<0.001), 3cm (592mmHgscm vs 192.6mmHgscm, p<0.0001) and overall MDA (714.2mmHgscm vs 259mmHgscm, p<0.001) (Figure 2). ROC curve analysis revealed the mean DCI thresholds for normal MDA to be 615mmHgscm at 11cm, 419mmHgscm at 7cm, 318mmHgscm at 3cm and 453mmHgscm for the overall MDA (Table 1).

Conclusions

The findings of this study show HRM and the clinical measurement DCI may be a suitable preoperative assessment for MSA. This translation of MDA to modernisation in manometry may assist surgeons adopt DCI which is regarded as more robust assessment that offers more detailed clinical information of the oesophageal motility health and disorder.
OGC O01 Minimally invasive or open oesophagectomy for localised oesophageal cancer: long-term follow-up of the ROMIO pragmatic randomised controlled trial
Authors: Blazeby Jane , Metcalfe Chris
Published: November 2023

Background

Patients with localised oesophageal cancer are frequently offered neoadjuvant treatment and surgery, with the benefit of improved survival but an expected at least short term negative impact on quality of life (QoL). Minimally invasive surgical techniques may reduce the QoL impacts by reducing tissue damage. The ROMIO study compared hybrid with open oesophagectomy, to test the hypothesis that hybrid allows faster recovery whilst maintaining the survival benefit of surgery. We have previously reported no evidence of a difference in early complications or recovery of physical function. Here we present the results of the comparison of longer term QoL and survival.

Methods

A pragmatic multi-centre randomised controlled trial was conducted in nine UK cancer centres. Patients with localised adenocarcinoma or squamous cell cancer were selected by multi-disciplinary teams for oesophagectomy with or without neoadjuvant treatment. Patients were randomly allocated to laparoscopic abdominal surgery and thoracotomy (hybrid) or open oesophagectomy. Surgery was quality assured by provision of a protocol, pre-operative video assessment of the 40 participating surgeons, and intra-operative photographs of key surgical components. Here we report on survival, and patient reported outcomes measured using the EORTC QLQ-C30, over 2 to 3 years post-randomisation.

Results

At enrolment 469 (89%) of 527 participants had an adenocarcinoma, 371 (71%) had a clinically staged T3 or T4a tumour, 296 (56%) had clinically positive nodes, and 438 (83%) underwent neoadjuvant treatment. Kaplan-Meier estimates of survival at 24 months were 66% in the hybrid surgery group (95% confidence interval 60% to 71%) and 65% in the open surgery group (95% confidence interval 57% to 69%) with the difference between the two groups being consistent with chance. Preliminary analyses did not provide evidence of a difference in patient reported quality of life following the two surgical approaches.

Conclusions

In contrast to the previous MIRO study, the ROMIO study has not identified any differences between hybrid and open surgery in complications, short-term recovery of physical function, or survival and quality of life over two to three years post-randomisation. Both approaches remain common in UK practice, with ROMIO providing evidence of their safety. Potentially, a fully minimally invasive approach, as investigated in the ROMIO phase 2b substudy and the TIME study, is required to realise the potential benefits of minimally invasive approaches.
OGC O04 The influence of age in oesophageal cancer treatment decisions: a machine-learning approach
Authors: Thavanesan Navamayooran , Farahi Arya , Walters Zoë , Underwood Timothy , Vigneswaran Ganesh
Published: November 2023

Background

Although patient age plays a crucial role in determining curative treatment options for Oesophageal cancer (OC), the exact extent of its influence is not well defined. We used an interpretable machine learning (ML) approach to model for the first time the exact impact of age in combination with other key decision-drivers, such as tumour and patient characteristics, on the predicted probability of receiving different types of curative treatment as determined by a single centre OC multidisciplinary team (MDT).

Methods

Retrospective analysis of 399 OC patients undergoing curative treatment between 2010-2020 at a tertiary unit. A random forests (RF) classifier model was trained to predict curative treatment decisions for OC patients (neoadjuvant chemotherapy (NACT) + surgery, neoadjuvant chemoradiotherapy (NACRT) + surgery or surgery alone). Variable importance (VI) and Partial Dependence (PD) analyses were used to map the importance of age in the model, its influence on the predicted probability of each treatment decision, and how that relationship was affected when interacting with other decision-driver co-variates.

Results

Age was the most important variable for the model (26% of total importance). PD analysis demonstrated that patients over 70 years had a substantially higher predicted base probability of receiving curative surgery and lower probability of NACT. Moreover, while the probability of receiving surgery and NACT was primarily driven by disease characteristics (T and N staging) in patients < 70 years, age became increasingly important in predicting a surgery-only decision in those >70 years (P< 0.001). The base probability of surgery and NACRT decisions was additionally influenced by performance status and age, but age alone for NACT patients.

Conclusions

We have successfully combined ML modelling with PD analysis in a novel approach within the OC space to delineate the relationship between age and OC treatment decisions. Age heavily influences curative decisions for OC patients but plays a greater role in patients with specific tumour characteristics. This study provides the basis of a ML approach for examining subconscious decision-drivers in the management of OC. This in turn allows OC MDTs to examine areas of potential health inequality which may result from variability within that decision-making framework.
AHP P02 Retrospective study reviewing post-operative feeding after gastric cancer surgery and the impact on outcomes
Authors: Bennett Helen , Harris Rhiannon , Owen Kellie , Grimshaw Kate , Alkhaffaf Bilal
Published: November 2023

Background

Gastric cancer patients are at increased risk of disease-related malnutrition due to the disease and the consequences of treatment. The variation in post-operative nutrition for this patient group may be impacting on outcomes, and further research has been recommended by the National Institute for Health and Care Excellence to help ascertain the safest and most effective method of nutrition support. The aim of this study was to help inform best practice regarding nutrition post-gastrectomy. The outcomes reviewed included length of stay (LOS), weight changes, complications and readmissions, and chemotherapy completion rates.

Methods

A regional tertiary Oesophago-gastric Centre was the setting for this study. Quantitative data of patients who had a gastrectomy secondary to gastric cancer over a 12-month period was collated. Weights from four timepoints during the multimodal treatment pathway were included. Baseline characteristics were reviewed, and patients grouped based upon their post-operative feeding route (no artificial nutrition, enteral nutrition, parenteral nutrition). Patients were also stratified by resection (partial, total or extended-total). IBM SPSS v26 was utilised for data analysis. Non-parametric tests were used as much of the data was not normally distributed.

Results

44 patients were included, (35 males) age 34-84 years. Partial gastrectomy patients lost an average of 7.2% bodyweight by six months post-operatively, versus 16.5% and 10.7% amongst those who had total and extended-total procedures. 27% (n=12) were known to be readmitted within six months of surgery, half with nutrition-related complaints. 19 patients received adjuvant chemotherapy, with 52% known to complete this. Weight loss in the initial post-operative period between those who did and did not complete chemotherapy was significantly different (6.8% versus 8.6%) (p=0.027). The patients with supplementary enteral nutrition completed chemotherapy, versus half of those only receiving oral nutrition.

Conclusions

Weight loss and inadequate nutrition after gastrectomy is significant and may have an impact on treatment pathways including the need for readmission. The study demonstrates a relationship between post-operative nutrition and adjuvant chemotherapy completion and warrants future prospective investigation. The study highlights the importance of providing adequate nutrition support throughout treatment and beyond for those patients undergoing a resection for gastric cancer.
AHP P06 Optimizing Coagulation Screen Practices in CVC Removal Amongst Surgical Patients: A Retrospective Audit Assessing Necessity, Compliance, and Implications
Authors: Shamiyah Khalid , Curry Nicola , Cunningham Chris
Published: November 2023

Background

Conflicting findings in recent literature question the significance of traditional coagulation variables in predicting bleeding associated with central venous catheter (CVC) removal. This audit evaluates the necessity and compliance of conducting same-day coagulation screens at Churchill Hospital. The study assesses the practice's relevance, compliance rates, and associated costs, offering implications for clinical decision-making, resource utilization, and potential modifications to current practices. The findings may lead to the adoption of new predictive factors or a targeted approach to coagulation testing, optimizing patient care and resource allocation in CVC removals.

Methods

This retrospective audit focused on surgical patients in the upper gastrointestinal, hepatobiliary and pancreatic, lower gastrointestinal, and transplant surgery departments at the Churchill Hospital. The study encompassed all instances of central venous catheter (CVC) removal that occurred between January 1st, 2022, and December 31st, 2022. Data retrieval was conducted using electronic patient records, and coagulation test results were interpreted utilizing the reference ranges available in the electronic patient record system (INR 0.9-1.2, PT 9-12, APTT 20-30).

Results

78 patients had an average age of 53 years and a mean hospital stay of 35 days. The average duration of CVC in-situ was 8.9 days. Patients underwent an average of 5.07 coagulation tests per stay, equivalent to 0.28 tests per admission day. Among the audited patients (n=67), 41.8% had same-day coagulation screens, 17.9% had the screen one day prior to CVC removal, and 40.3% had the screen more than one day before removal. Analysis showed that 88% had normal INR values, with only eight patients having abnormal values. Furthermore, 74.6% and 58.2% had normal PT and APTT values, respectively.

Conclusions

This retrospective audit of CVC removals in surgical patients at Churchill Hospital revealed a concerning in-compliance rate of 44% with coagulation screens during CVC removals. Most patients had normal coagulation parameters, questioning the need for same-day screens. Delays and high costs (£64.76 per patient, £12.95 per screen) were incurred. Individualized risk-based approach, considering bleeding history, could be more efficient. Implementing targeted coagulation testing saves costs and optimizes resource utilization. Further evaluation required to improve patient care and resource allocation in CVC removals, reducing reliance on routine same-day screens.
EGS P02 Lessons learnt from 450 Endoluminal vacuum therapy (EVT) procedures in the treatment of upper gastrointestinal perforations and leaks
Authors: Farooq Naheed , Alkhaffaf Bilal
Published: November 2023

Background

Endoluminal vacuum therapy (EVT[BA1] ) is a novel, yet relatively well established tool in the management of upper gastrointestinal (UGI) leaks and perforations. Despite a growing body of evidence supporting its use, management strategies and techniques used in the context of EVT are yet to be standardised. Furthermore, the uptake of EVT in the UK is limited to a small number of centres. This project aimed to summarise the key lessons learnt from our initial experience of 450 EVT procedures, to inform others about how this technique can be integrated into regular clinical practice.

Methods

This study draws on experiential reflections and analysis of a prospective database of 450 EVT procedures in 59 patients in our unit from October 2018 – June 2023. This included patients who had undergone oesophago-gastric (OG) cancer resections, bariatric surgery (index procedures both in the UK and abroad) and those presenting with benign disease (oesophageal perforation and iatrogenic injury). The setting was a regional tertiary OG and bariatric centre in the North West of England serving a cancer and benign population of 3.5 million people and a larger undetermined population for bariatric emergencies.

Results

51/59 (86%) patients were successfully managed with 446 EVT procedures. Patient, system and technical factors were identified which when addressed, facilitated expeditious healing of leaks, and enabled active management patients unfit for more invasive interventions. Factors included understanding the indications for using and stopping EVT, control of sepsis, and optimisation of nutrition and glycaemic control. Technical factors included sponge placement, managing foreign material (e.g. redundant sutures and drains) and approaches to managing necrosis. System factors included supporting a training programme, the necessity of a comprehensive team approach and the financial and governance challenges with adopting a novel intervention.

Conclusions

EVT is as an effective technique in the management of complex UGI leaks and perforations. There are multiple patient, financial, logistical, governance and systems factors that present as challenges to the implementation of this technique into routine practice. An integrated team-based approach is key to adoption of EVT by other centres into their routine practice.
EGS P10 A multi-centre prospective cohort study to identify factors predictive of poor functional recovery for older patients facing major gastrointestinal surgery (OCTAGON study): A subgroup analysis of older patients undergoing non-curative procedures or conservative management
Authors: Daniels Sarah , Rashid Adil , Lee Matthew , Moug Susan , Wilson Tim , Brown Steven , Wyld Lynda
Published: November 2023

Background

Increasing age and frailty are associated with ‘futile’ emergency GI surgery and increased 30-day mortality after elective surgery. Consequently, older patients may be deemed “unfit” for major GI surgery, due to perceived risk of poor outcomes such as prolonged hospitalisation, poor functional recovery or mortality. Little is known about the baseline health characteristics and outcomes of the “unfit” group, with only a small number of studies performed on this patient group to date. This study aimed to comprehensively assess the baseline characteristics and functional trajectories of patients deemed “unfit” for major surgery using validated questionnaires.

Methods

This prospective, multicentre cohort study included patients aged 65 years or older with a diagnosis of elective or emergency GI pathology amenable to curative major GI surgery. Patients who underwent risk-adapted procedures or conservative management instead of curative major GI surgery formed the “unfit” cohort. Risk-adapted procedures included endoluminal stenting, defunctioning stomas and percutaneous tumour ablation. Baseline patient characteristics were recorded. Patients were followed up at 6 weeks, 3 months, and 6 months to assess survival, patient reported functional recovery using the World Health Organization Disability Assessment Schedule (WHO-DAS) questionnaire and quality of life using EQ-5D-5L.

Results

19 patients formed the “unfit” cohort. 10 patients presented electively and 9 presented as an emergency. Within the elective group 30% were classified as frail and 20% required carers, in comparison to 89% and 56% respectively in the emergency group. Baseline WHODAS indicated higher patient reported disability in the emergency group. 6-month mortality was 40% in the elective group and 44% in the emergency group. At 6 weeks, functional status declined in both the elective and emergency groups. Only small numbers of patients completed follow-up at 3 and 6 months due to death prior to follow-up.

Conclusions

This study comprehensively assessed baseline functional status and quality of life in elective and emergency patients who were “unfit” for major GI surgery. The study found high rates of baseline frailty and functional disability, particularly amongst those who presented via emergency pathways. Over half of patients were alive at 6 months, but with high levels of functional impairment, suggesting that these patients may benefit from early involvement from geriatric and palliative care specialists. Further research is needed to improve outcomes in this understudied surgical population.
EGS P13 Adherence to Guidelines for Post-Splenectomy Patients in a Primary Care Practice in North West England
Authors: Sharif Faraz , Alam Imran , Tankard Justin
Published: November 2023

Background

Splenectomy is indicated in haematological, oncological disorders and occasionally during emergency (trauma) surgery. Given the spleens role in the immunological response, overwhelming infection remains an area of concern for post-splenectomy patients with low prevalence (0.1-0.5%) but high mortality (∼50%). Strep pneumoniae, H influenzae Type B and Neisseria meningitidis are common bacterial perpetrators.

At present, Public Health England and the British Society for Haematology recommends regular influenza, pneumococcal and meningococcal vaccinations for patients with asplenia or hyposplenism. They should also be on lifelong prophylactic antibiotics.

This audit aimed to assess the adherence to vaccination and antibiotic prophylaxis guidelines for post-splenectomy patients.

Methods

19 patients post splenectomy patients were identified at a primary care practice in North West England. Data was retrospectively collected from the last 10 years with two researchers manually searching through their GP records. Parameters collected included both compliance and timeliness with vaccinations and antibiotic prophylaxis as per national guidance. Where there was a deviation from the guidance, the records were again searched to identify any cause.

Results

109/162 (67.3%) ‘vaccination opportunities’ for the recommended yearly influenza vaccination were successfully delivered.

17/19 (89.4%) patients had no documented initial pneumococcal vaccination at time of splenectomy.

23/162 (14.2%) influenza and 22/37 (56.4%) pneumococcal vaccination opportunities were missed with no documentation explaining why.

Only 1 patient received the recommended MenACWY/MenB vaccination at diagnosis, 5 received delayed vaccinations and 13/19 (68.4%) patients received no meningitis vaccination.

7/19 (37%) patients were not on prophylactic antibiotics as recommended with no documented explanation. 2 of those patients were issued one-off antibiotic prescriptions and 1 had their prescription stopped due to non-compliance.

Conclusions

Significant improvement is needed with regards to antibiotic prophylaxis, pneumococcal and meningococcal vaccinations with over 50% of vaccinations being missed. Poor documentation and a shift to electronic health records are possible factors that have affected data collection, particularly as a significant number of the splenectomies performed were prior to 2000. Recommendations include routine reviews for asplenic patients, encouragement for opportunistic vaccination and increasing awareness of the risks of post-splenectomy sepsis and the benefits of vaccinations. Future scope could include looking at the same guidelines for other hyposplenic/asplenic conditions.
EGS P18 A single centre retrospective audit into the early management of acute pancreatitis in an UK District General hospital
Authors: Karagiannidis Georgios , Abdallah Mohamed , Patel Roshni , Youssef Fahed
Published: November 2023

Background

In the UK, the incidence of acute pancreatitis is approximately 56 case per 100,000 people per year. It is a complex disease, and the treatment of pancreatitis can vary significantly between different regions regardless of the numerous national and international guidelines.The purpose of this audit is to compare the diagnosis and management of pancreatitis at Ipswich hospital with other hospitals that have participated in the PANC study. We also compared the ideology and mortality rate. By doing so, we can establish a foundation for future management plans and guidelines at Ipswich hospital.

Methods

This audit was conducted at Ipswich hospital for four months, from November 1st, 2022 to April 30th, 2023. It was a single-centre prospective cohort study that included all patients diagnosed with pancreatitis in accordance with the Modified Atlanta Classification and presented within the four months. Data was collected from the time of admission to discharge or death and included patient demographics, bloods on admission, investigations, aetiology, management and complications.

Results

A total of 87 patients were admitted to Ipswich hospital with a diagnosis of pancreatitis during this time frame.The most common etiology was gallstones(45%,PANC 50.6%),followed by idiopathic(33%,PANC 22.4%)and lastly EtOH(18%).Only 45% of those with idiopathic pancreatitis underwent further idiopathic pancreatitis screen and 10% had EUS.The most common imaging used was CT scan (51%, PANC 53%), majority of those scans were performed within the first 24 hours of admission and 33% of patients with diagnostic amylase underwent a CT. 55% of patients were started on antibiotic in the first 48 hours of admission (PANC 34.6%).

Conclusions

The data collected from within Ipswich hospital was similar to that found in the PANC study. This suggests that the diagnosis and management of pancreatitis is somewhat similar across the UK. The rate of Idiopathic pancreatitis was much higher than expected and higher than the PANC study. Similar to the PANC study, there is an overuse of CT scan for diagnosis of pancreatitis which is not in accordance with the royal college of radiology guidelines.