bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic performance of image-guided vacuum-assisted breast biopsy after neoadjuvant therapy for breast cancer: prospective pilot study
Authors: Rossi Elisabetta M C , Invento Alessandra , Pesapane Filippo , Pagan Eleonora , Bagnardi Vincenzo , Fusco Nicola , Venetis Konstantinos , Dominelli Valeria , Trentin Chiara , Cassano Enrico , Gilardi Laura , Mazza Manuelita , Lazzeroni Matteo , De Lorenzi Francesca , Caldarella Pietro , De Scalzi Alessandra , Girardi Antonia , Sangalli Claudia , Alberti Luca , Sacchini Virgilio , Galimberti Viviana , Veronesi Paolo
Published: December 2022

Background

Image-guided vacuum-assisted breast biopsy (VABB) of the tumour bed, performed after neoadjuvant therapy, is increasingly being used to assess residual cancer and to potentially identify to identify pathological complete response (pCR). In this study, the accuracy of preoperative VABB specimens was assessed and compared with surgical specimens in patients with triple-negative or human epidermal growth factor receptor 2 (HER2)-positive invasive ductal breast cancer after neoadjuvant therapy. As a secondary endpoint, the performance of contrast-enhanced MRI of the breast and PET–CT for response prediction was assessed.

Methods

This single-institution prospective pilot study enrolled patients from April 2018 to April 2021 with a complete response on imaging (iCR) who subsequently underwent VABB before surgery. Those with a pCR at VABB were included in the primary analysis of the accuracy of VABB. The performance of imaging (MRI and PET–CT) was analysed for prediction of a pCR considering both patients with an iCR and those with residual disease at postneoadjuvant therapy imaging.

Results

Twenty patients were included in the primary analysis. The median age was 44 (range 35–51) years. At surgery, 18 of 20 patients showed a complete response (accuracy 90 (95 per cent exact c.i. 68 to 99) per cent). Only two patients showed residual ductal intraepithelial neoplasia of grade 2 and 3 respectively. In the secondary analysis, accuracy was similar for MRI and PET–CT (77 versus 78 per cent; P = 0.76).

Conclusion

VABB in patients with an iCR might be a promising method to select patients for de-escalation of surgical treatment in triple-negative or HER2-positive breast cancer. The present results support such an approach and should inform the design of future trials on de-escalation of surgery.
BS O01 Closure of mesenteric defects during laparoscopic roux-en-y gastric bypass surgery and its effect on internal hernia rates and small bowel obstruction: A Meta- Analysis
Authors: Thomas Rhys , Chalklin Christopher , Carrington-Windo Elliot , Beamish Andrew , Barry Jonathan
Published: December 2022

Background

Roux-en-Y gastric bypass surgery is an important treatment for obesity and it's related diseases, however internal herniation and small bowel obstruction from mesenteric defects can lead to reoperation in 10–16% of patients. This can be early (<30 days) or late. Routine closure of meso-jejunal defecfs and/or Petersens defect is still not adopted worldwide.

Our objective was to systematically review and analyse pooled data from all studies, evaluating the impact of routine closure of mesenteric defects on the incidence of internal hernia in laparoscopic antecolic Roux-en-Y gastric bypass (RYGB) surgery for obesity. Secondary endpoints for analysis included the incidence of early and late small bowel obstruction (SBO), need for reoperation, bleeding, anastomotic leak, marginal ulceration and weight loss.

Methods

Ovid, MEDLINE, EMBASE and Cochrane databases were searched on 13 September 2021 using a combination of MeSH and non-MeSH terms, including ‘gastric bypass’, ‘mesenteric defect’, ‘hernia’, and ‘small bowel obstruction’. Studies comparing closure with non-closure of mesenteric defects were included. Two researchers independently examined titles, then abstracts, and finally, full text articles. Disagreements were arbitrated with the senior author.

Fixed- or random-effect models were used, as appropriate. Results have been reported with 95% confidence intervals and I-squared indices to assess uniformity among results for each outcome measured.

Results

Seventeen studies met the criteria and were included, including two randomised trials. A total of 61,220 patients were included with follow-up ranging from 24–120 months. In the closure group the incidence of all types of internal hernia was lower (OR 0.22, 95% CI 0.19, 0.26), SBO beyond 30 days was less frequent (OR 0.47, 95% CI 0.44,0.52), and the reoperation rate was lower (OR 0.22, 95% CI 0.19,0.26). The incidence of SBO within 30 days was higher in the closure group (OR 1.34, CI 1.07,1.68).

Conclusions

This new pooled analysis updates previous meta-analyses, adding data from eight additional studies and almost 45,000 additional patients. This provides firm evidence that routine closure of mesenteric defects during laparoscopic gastric bypass reduces rates of internal herniation and SBO beyond the post-operative period. Closure of the mesenteric defects should be standard practice in RYGB. A higher incidence of early SBO was notable in the closure group, postulated by some studies as attributable to technical factors, including kinking of the jejunal anastomosis and bleeding. This must be considered when closing defects.
BS O09 Enhanced recovery and fast track surgery is applicable with good outcomes in patients undergoing bariatric surgery
Authors: Ahmad Adil , Mahmood Fahad , Massey Daniel , Fagbemi Ona-Omovefe , Nanthakumar Nakulan , Sokhal Balamrit , Salgaonkar Hrishikesh , Sharples Alistair , Marimuthu Kanagaraj , Balaji Nagammapudur , Rao Vittal
Published: December 2022

Background

Fast track surgery is well established in major centres undertaking bariatric surgery

Methods

All patients who underwent bariatric surgery in a high volume centre were included. Patient outcomes in terms of complication rates, length of stay, one day discharge rate and 30 day readmission rate were analysed.

Results

1009 patients (105 gastric band removal, 756 gastric bypass, 104 sleeve gastrectomy and 44 revision surgery) were included in the study. Demographics include: Age 46(20–77), M:F = 190–819; BMI – 44.3 (20.6–62); Wt. – 120.3 Kg (57.4–190.7). Median length of stay was 1.7 (1–23) with 79% 1 day discharge. 19 patients had complications (1.8%) with no mortality. Logistic regression analysis revealed that presence of co-morbidities (OR = 1.92; 95% CI: 1.26–2.94; p=0.002) and history of previous abdominal surgery (OR = 2.22; 95% CI: 1.27–3.89; p = 0.005) increases risk of delayed discharge. The 30 day readmission rate was significantly higher in patients who had concomitant surgery in addition to primary bariatric surgery (Chi squared test p=0.032) and patients who failed the fast track protocol (p-0.000; chi squared = 13.2)

Conclusions

Increased understanding of factors which can be optimised may result in even better outcomes in fast track bariatric surgery.
OGC O05 Does Minimally Invasive Transthoracic Esophagectomy Reduce Postoperative Pulmonary Complications? An International Cohort Study from the Oesophagogastric Anastomosis Audit (OGAA)
Authors:   Oesophagogastric Anastomosis Audit Collaborative, Kamarajah Sivesh
Published: December 2022

Background

Ongoing debate exists around optimum surgical approach to esophageal cancers, with limited data characterizing the external validity of randomised trials on MIE for esophageal cancers. This study aimed to report the postoperative pulmonary outcomes of transthoracic minimally invasive esophagectomy (MIE) in esophageal cancers patients from an international, multicenter cohort.

Methods

Patients undergoing open (OE, n=744), hybrid (HE, n=500), and totally MIE (TMIE, n=540) for esophageal cancers were identified from the Oesophagogastric Anastomosis Audit (OGAA).

Results

PPC rates were lower after MIE compared to OE and HE (31% vs 38% vs 39%, p=0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.57, CI95%: 0.44–0.74). MIE was associated with higher rates of AL (16% vs 11% vs. 11%, p=0.026), but not overall complications (60% vs 65% vs. 62%, p=0.2) and 90-day mortality compared to OE and HE (3% vs 4% vs. 3%, p=0.6). On adjusted analyses, MIE was associated with lower overall complications (OR: 0.67, CI95%: 0.51–0.87), but not AL (OR: 1.39, CI95%: 0.96–2.01) and 90-day mortality (OR: 0.49, CI95%: 0.22–1.04) compared to OE.

Conclusions

In contrast to previous reports, this study provides real-world data that TMIE was associated with lower 90-day PPC 90- than OE and HE, especially in patients with higher ASA grades and underlying respiratory disease. These warrant a further review into causes and mechanisms in selected patients, and that quality assurance in delivery of TMIE is probably of major importance. Finally, the proxies of oncologic impact, such as R0 rates and extend of lymphadenectomy, are superior with the TMIE approach. The ideal surgical approach remains unclear, and may be context dependent, and ongoing trials such as ROBOT-II will provide a large body of randomized data within a few years that may clarify the optimum approach to locally advanced esophageal cancers.
OGBN P19 Tackling a post-COVID-19 cholecystectomy waiting list, are we meeting the challenge?
Authors: Hamid Mohammed , Mirtorabi Neginsadat , Ghumman Abdul , Khalid Ayesha , Noor Saleem , Kapoulas Spyridon , Singhal Rishi , Nijjar Rajwinder , Richardson Martin , Wiggins Tom
Published: December 2022

Background

The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity, with over six million people on waiting lists and only 64% of patients meeting the 18-week elective standard. Our Hospital Trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times.

Methods

A prospective observational study was undertaken investigating patients who received a cholecystectomy at large UK hospital Trust, between February 2021 and February 2022. There were multiple phased strategies to tackle a 533 patient waiting list: private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. An additional 364 patients were added and 145 removed, for multiple reasons, from the list during the study period. Correlation of determination (R2) and Kruskal-Wallis analysis were used to evaluate trends in waiting times across the study period.

Results

657 patients underwent a procedure, of which 628 (95.6%) were completed electively. The median age was 49 years, 602 (91.6%) patients had an ASA of 1–2, and 494 (75.2%) were female. Thirty (4.6%) patients were listed post gallstone pancreatitis, 380 (57.8%) for cholelithiasis, and 228 (34.7%) for cholecystitis. The median length of stay was zero days (IQR 0–1), with 30-day complication (C-D ≥3, 1.8%), readmission (3.0%) and mortality (0.0%) rates noted. The current waiting list includes 95 patients, with median waiting times reduced from 428 days (IQR 373–508) to 49 (IQR 34–96), R2=0.654, p<0.001. For pancreatitis specifically, waiting times have dropped from a median of 218 days (IQR 139–239) to 28 (IQR 24–40), R2=0.613, p<0.001.

Conclusions

We have safely and effectively tackled the cholecystectomy waiting list locally utilising a number of phased strategies. Significant progress is being made towards once again meeting the gold-standard target for gallstone pancreatitis patients. The approach utilised here has potential to be adapted to other units, or other operation types in order to reduce elective waiting times.We have safely and effectively tackled the cholecystectomy waiting list locally utilising a number of phased strategies. Significant progress is being made towards once again meeting the gold-standard target for gallstone pancreatitis patients. The approach utilised here has potential to be adapted to other units, or other operation types in order to reduce elective waiting times.
EGS P01 The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people
Authors: Akhtar Amina , Brooks A , O'Connor R
Published: December 2022

Background

There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter.

Methods

Data was retrieved for patients between 10–25 years old from the national Trauma Audit and Research Network (TARN) database, who had been involved as pedestrians in motor vehicle accidents between 2015–2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time and mortality were analysed according to the hours of daylight, darkness and season.

Results

The study identified a seasonal pattern, showing that autumn was the predominant season and lead to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500–1630 correlating to school pick up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124) with moderate injuries (ISS 9–14) occurring most commonly during the day (72.7%) and more severe injuries (ISS>15) occurred during the night (55.8%).

Conclusions

We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick up times may play a significant role . This could be addressed through a targeted public health approach to implement change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.
EGS P14 Can preoperative Neutrophil-lymphocyte ratio predict post-operative complications in appendicectomy?
Authors: Galbraith Norman , Khan Khurram , Gall Lewis , Macdonald Andrew
Published: December 2022

Background

Complications after appendicectomy remain common. Neutrophil-lymphocyte ratio (NLR) measures inflammation by incorporating the innate and adaptive components of the circulating immune system. We hypothesised that pre-operative NLR could predict post-operative complications after emergency appendicectomy.

Methods

A multicentre retrospective observational study was performed investigating all adults undergoing emergency appendicectomy across four hospital (2 teaching centres and 2 district general hospitals) between August 2018 and November 2020. Patients were identified through pathology records. Electronic records were studied for patient demographics, pre-operative routine laboratory tests, imaging, operative details, and post-operative complications. Neutrophil-lymphocyte ratio was calculated by dividing the pre-operative neutrophil count value by the lymphocyte value. A threshold of 8 was used based on previous literature.

Results

There were 1130 patients identified who underwent emergency appendicectomy, with 43.6% female. ASA level was I or II in 93.8% of patients, and 82.3% underwent a laparoscopic approach. Perforated appendicitis was observed in 21.7% of patients and two patients died. Mean NLR was 10.3 (SD 8.2), with 50.9% of patients with an NLR of >8. NLR >8 was associated with deep surgical site infections (SSI) (p < 0.001). NLR > 8 was predictive of deep SSI with an odds ratio of 3.455 (CI 1.840–6.488, p < 0.001).

Conclusions

The NLR is an easy to calculate parameter which, when higher than 8, predicts deep surgical site infection following emergency appendicectomy and may help guide perioperative decision making such as antibiotic duration.
EGS P16 Management of Acute Gallstone disease at an urban acute Trust during the pandemic
Authors: Sharif Mohammad , Osilli Dixon , Darren Patten , Amalesh Thangadorai , Di Maggio Francesco , Mukherjee Samrat , Mukherjee Dipankar
Published: December 2022

Background

Acute gallstone disease is a surgical emergency. Management has evolved over the years with emphasis on early surgery to improve outcomes. However, due to resource limitations, cholecystectomy is often delayed leading to repeated admissions, interval complications and increased costs.

Despite several nationwide initiatives to implement acute cholecystectomy pathways, the SWORD (Surgical Workload Outcomes Audit Data Tool) quality improvement project reports emergency Cholecystectomy rates for gallstone disease as low as 1.2% to 36.5% in NHS acute hospital trusts between 2012 and 2017.

We analysed the current situation at Barking, Havering and Redbridge NHS Trust serving a population of 750,000 during the pandemic.

Methods

Patients presenting with acute gallstone disease (acute cholecystitis, biliary colic, and gallstone pancreatitis) between September and December 2021 were retrospectively audited. We measured re-admission rates, number of emergency and elective cholecystectomies performed, post-operative complications and interval between operation and initial admission.

Results

240 patients were admitted with acute gallstone disease during the audit period. 133 (55%) patients were admitted with acute cholecystitis, 77 (32%) for biliary colic and 30 (13%) with gallstone pancreatitis. 91 (35%) were re-admissions while waiting surgical management. 110 (46%) patients had a definitive management, either during or following their initial admission.

At 3 months following end of audit period, 49 (44.5%) patients underwent cholecystectomy, of which only 10 (20%) were performed acutely. However, 70% of acute operations were performed during re-admissions. The average time between admission and operation was 63.57 days for new presentations, compared to 49.89 days for re-admissions. 47 of the 240 patients re-presented to hospital with symptoms before their operation during the study period: 11 (23%) with biliary colic, 29 (62%) with acute cholecystitis and 7 (15%) patients with acute gallstone pancreatitis.

From the main cohort of 240, 31 (13%) patients were either not deemed fit for surgery or lost to follow-up) while 99 (41%) patients were still awaiting decision about definitive management.

Conclusions

Provision of emergency cholecystectomies does not comply with national guidelines. Frequent re-admissions worsen patients’ experience. Cholecystectomies took place in very few patients at index admission during pandemic. More financial and cultural resources need to be allocated nationwide to surgically face the gallstone epidemic.
EGS P31 A Rare Case of Jejunal Obstruction Secondary to Necrotic Peripancreatic Abscess (CASE REPORT)
Authors: Likoscorbett Marina , Kudchadkar Shantata , Mathema Sina , Egboka Ejike Aloysius , Ayathamattam Joseph , Harris Guy
Published: December 2022

Background

Acute pancreatitis is one of the major causes for emergency hospital admissions worldwide. Bowel obstruction following acute pancreatitis usually occur as a result of retroperitoneal inflammation and mesenteric infiltration in the inflammation; especially at duodenum, transverse colon and splenic flexure due to the proximity to pancreas. We hereby, present a rare case of jejunal obstruction secondary to sterile necrotic peripancreatic abscess. Through this case report, we aim to emphasize increased awareness required among general surgeons and the need for appropriate clinical judgement in the management of bowel obstruction - medical versus surgical intervention.

Methods

Case Report: A 65-year-old lady presented in emergency with an acute 10-hour history of epigastric pain with nausea. She drank no alcohol, was otherwise well and had no other significant co-morbidities. On examination, she was tender in the epigastrium with no signs of peritonitis. She had raised serum amylase diagnostic of acute pancreatitis. All other blood investigations and an ultrasound abdomen was unremarkable. The cause of pancreatitis was unclear. She was admitted and treated in a conventional fashion.

Over next 2 days, the patient's C-reactive protein increased and she became hypotensive warranting HDU care. Computed Tomography of abdomen and pelvis (CTAP) confirmed acute pancreatitis with no associated complications. She made slow progress. A Nasojejunal tube was inserted for nutritional support. Over the next five days, she had abdominal distention with absolute constipation and was treated for ileus. Further CT imaging suggested partial small bowel obstruction. Clinical condition failed to progress despite 48 hours of conservative management and decision was taken for a diagnostic laparoscopy.

Results

Intra-operatively, multiple small bowel loops were found densely adherent to the inferior border of pancreas, each with a clear evidence of upstream bowel dilatation. The cause was a peripancreatic necrotic abscess cavity. Laparoscopic division of adhesions allowed access to the cavity. A washout was performed and a drain inserted. Post-operatively, she had an uneventful recovery. She was gradually built on enteral nutrition and her bowels started working normally. She was discharged on post-op day 5 and drain removed as an outpatient. She had no complications at 60-day follow-up.

Conclusions

Bowel complications of acute pancreatitis (paralytic ileus, mechanical obstruction, bowel ischaemia and perforation) are relatively infrequent, with few cases reported in literature. Prediction of disease severeity is crucial to guide the treatment plan. In majority of cases, abdominal distention and absolute constipation is usually ileus and managed conservatively. Care should be taken in unsettling patients and diagnostic laparoscopy should be undertaken to evaluate the cause and manage accordingly.
HPB P03 Oncological outcomes are comparable between octogenarians and younger patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma
Authors: Pande Rupaly , Attard Joseph , Al-Sarireh Bilal , Bhogal Ricky , Farrugia Alexia , Fusai Giuseppe , Harper Simon , Hidalgo-Salinas Camila , Jah Asif , Marangoni Gabriele , Mortimer Matthew , Pizanias Michail , Prachialias Andreas , Roberts Keith , Hee Chloe Sew , Soggiu Fiammetta , Srinivasan Parthi , Chatzizacharias Nikolaos A
Published: December 2022

Background

Oncological outcomes are comparable between octogenarians and younger patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma

Methods

A multicentre case-control study of octogenarians matched on complexity of surgery with consecutive younger controls who underwent PD for PDAC (2008–2017).

Results

Some 220 patients were included, 110 octogenarians (age 81 (80–83)) and 110 controls (age 69 (62–74)). Charlson Comorbidity Index score was higher in octogenarians than controls (7 (6–8) vs 5 (4–6)), p<0.0001) but Eastern Cooperative Oncology Group performance status (Groups 0–1: 99 vs 98; 2–3: 5 vs 4, p=0.756) and ASA (ASA 1–2: 72 vs 77; 3–4: 20 vs 18; p=0.635) were comparable. Adjuvant therapy was delivered more commonly in the younger cohort (76.2 vs 58.0%, p= 0.007). Tumour stage, lymph node ratio and resection margin status were comparable between groups. There was no difference between octogenarians and controls in OS (20 (14–26) vs 29, (24–24) months p=0.095) or DFS (19,(13–24) vs 22,(15–29) months p=0.742). On multivariate analysis, age was not a risk predictor.

Conclusions

In selected fit octogenarians, equivalent survival is achievable. Centralisation and multimodal therapy are key. Pre-operative risk stratification using at ECOG and albumin level can be used to identify an appropriate population.
HPB P09 Forgotten ERCP Stents: Is a National Registry Required
Authors: Clements Caterina , Bezzaa Sabrina , Curwen Oliver , Kersey James , Nehra Dhiren , Jamal Karim , Lewis Trystan
Published: December 2022

Background

Pre-operative endoscopic retrograde cholangiopancreatography (ERCP), stone removal and interval cholecystectomy is the widely practiced management for choledocholithiasis with concomitant gallstones.

Biliary stenting is performed with plastic or metallic stents which require removal after 3–6 months.

The sequelae from the forgotten biliary stent following laparoscopic cholecystectomy, stent occlusion, migration or cholangitis, carry significant morbidity and cost implications.

Methods

Pre-operative endoscopic retrograde cholangiopancreatography (ERCP), stone removal and interval cholecystectomy is the widely practiced management for choledocholithiasis with concomitant gallstones.

Biliary stenting is performed with plastic or metallic stents which require removal after 3–6 months.

The sequelae from the forgotten biliary stent following laparoscopic cholecystectomy, stent occlusion, migration or cholangitis, carry significant morbidity and cost implications.

Results

308 laparoscopic cholecystectomies were performed in the study period. 25 (8%) underwent pre-operative biliary stenting, of these 16 underwent successful stent removal.

7 patients are still awaiting removal and 2 were discharged without stent removal and lost to follow up. One of these required emergency admission and removal of the stent at a tertiary centre due to stent complication.

The average time from biliary stenting with ERCP to cholecystectomy was 99 days. The average time from cholecystectomy to removal of biliary stents was 113 days. The average length of time from insertion of biliary stent to removal was 195 days.

Conclusions

Where common bile duct exploration at the time of cholecystectomy is not possible we recommend ERCP units provide a stent registry system with a deadline for biliary stents in the registry system for each patient.
HPB P32 Cancellations of elective theatre on the scheduled day of surgery at a tertiary referral hospital
Authors: Nessa Ashrafun , Pawloy Karola , Ganeshamoorthy Kajenthiny , Tan Jiaying , Weston Oliver , Maclean Duncan , Ghazanfar Mudassar , Radhakrishnan Ganesh
Published: December 2022

Background

Cancellations of elective theatre has negative impact on patients, hospital staff and training of surgical trainees. It reduces the efficiency of theatre and causes significant financial loss for the health care system. The cancellation rate in the developed country ranged from 2 to 40%.The objective of current study was to report the rates and reasons for elective theatre cancellation.

Methods

The data of cancelled cases were collected by Department of eHealth. The report was used to identify the cancelled cases and further demographic details and waiting time and outcome were collected and simple descriptive and basic analysis was done.

Results

121 cases were cancelled over 9.5 months from 1/12/2020–16/09/2021. The incidence rate of cancellation is ---. 2 most common cancelled cases were Lap chole (27.3%, n=33) and EUA rectum (8.3%, n=10). 24% (n=20) of the cancelled cases were cancer. Commonest reason for cancellation were unavailability of bed 39% (n=47) and not enough time 32% (n=39). 82%(n=100) reasons for cancellation were deemed avoidable. 7% patients had cancellation twice. The mean waiting time since cancellation to surgery was 52 days, median 35 days. 5% patients were admitted to hospital while awaiting surgery. 3% had passed away while waiting.

Conclusions

This study identified the most common reasons for theatre cancellation at a tertiary hospital in Scotland which include unavailability of beds and not enough time. Improved theatre efficiency and booking schedule can help alleviate cancellation. Identification of the Potential avoidable causes can help conform interventions and formulate further research, influence national policies.
HPB P43 Stereotactic ablative radiotherapy is a safe and feasible option for non-surgical candidates with colorectal liver metastases
Authors: Barrie Jenifer , Taylor Sarah , Barwell Lynsey , Cameron Iain
Published: December 2022

Background

Stereotactic ablative radiotherapy (SABR) has been associated with an improvement in over-all survival in patients with oligometastatic colorectal cancer with a controlled primary tumour and one to five oligometastatic lesions. We report our centre's experience of SABR as an alternative local therapy for non-surgical candidates with colorectal liver metastases.

Methods

All patients were identified who received SABR irradiation for colorectal liver metastases in a tertiary HPB centre between June 2016 and February 2022. SABR criteria included patients with 1–3 liver metastasis with maximum tumour diameter < 6 cm, liver confined disease and a suitable performance status with pre-treatment Child-Pugh status A. A retrospective review of the patient's scans, letters and MDT outcomes was performed to analyse the pathology, indications and outcomes.

Results

18 patients with oligometastatic colorectal cancer received SABR to metastases in the liver over the study period. Five were female and 13 were male. Median age was 71. Performance status was 1 in the majority of cases (10/18). Only 2 patients had synchronous disease. 4 patients had concomitant metastatic disease to the lung and all 4 had had a lung resection. Half of the patients had a previous liver resection with 2 of these having two previous liver resections and 1 having 3 liver resections. 4/18 patients underwent SABR because they were deemed unfit for surgery, 6/18 were for anatomical indications with risk of an R1 resection and one was down to patient choice. Metastases were of median size 30 mm (9–87 mm). 89% (16/18) patients had a single metastasis, 1 patient had 2 metastases and 1 patient had 3 metastases.

Overall survival was 19 months (4–60 months). 3 patients achieved complete resolution of disease and 4 patients had partial resolution. 6 patients were deemed to have stable disease and 4 patients had disease progression. Outcome data was not available in 1 patient. Only 2/18 pa

Conclusions

We observed that SABR is feasible, well tolerated and effective in this cohort of patients. Longer-term follow up data is required to assess a survival benefit.
HPB P49 Vein wall invasion is a more reliable predictor of oncological outcomes than vein related surgical margins after pancreaticoduodenectomy for early stages of pancreatic ductal adenocarcinoma
Authors: Ahuja Manish , Pande Rupaly , Raza Syed Soulat , Bartlett David C , Dasari Bobby , Marudanayagam Ravi , Mirza Darius , Roberts Keith John , Issac John , Sutcliffe Robert P , Chatzizacharias Nikolaos A
Published: December 2022

Background

Pancreaticoduodenectomy (PD) with vein resection is the only potentially curative option for patients with pancreatic ductal adenocarcinoma (PDAC) with venous involvement. The aim of our study was to assess the oncological prognostic significance of the different variables of venous involvement in patients undergoing PD for resectable and borderline resectable with venous only involvement (BR-V) PDAC.

Methods

Retrospective analysis of prospectively maintained PD database from 2011–2020 was performed. Standard descriptive statistical analysis; statistical comparisons with the use of the appropriate test; survival analysis with the Kaplan-Meier method and log rank test for overall survival (OS), disease-free survival (DFS) and local recurrence (LR); risk analysis for separate surgicalmargins with univariable and multivariable Cox proportional hazard model were used.

Results

One hundred and five of 372 patients (28%) required vein resection and vein wall involvement was identified in 37% of those. More vein resections were performed in female patients and as expected for BR-V disease.

OS, DFS and LR were significantly longer after R0 resection, irrespective of the need for a venous resection. Following analysis of separate surgical margins, the vein groove and the vein transection margins (the latter only applicable in patients that had a venous resection) were not identified as predictors of oncological outcomes. On the contrary, vein wall invasion was an independent predictor of OS (HR:1.947, CI: 1.228–3.089, p=0.005), DFS (HR: 2.169, CI: 1.306–3.602, p=0.003) and LR (HR: 2.365, CI: 1.089–5.133, p=0.030) after PD with venous resection.

Conclusions

Vein wall tumour invasion may be a more reliable predictor of oncological outcomes compared to traditionally reported parameters. Future studies should focus on possible pre-operative investigations that could identify these cases and management pathways that could yield survival benefit, such as the use of neoadjuvant treatments.
HPB P52 Presentation of acalculous cholecystitis - Are patients with acalculous cholecystitis critically unwell?
Authors: Suresan Srutti , Shaukat Mubasher , Ahmad Reddin , BinSahl Abdullah , Naeem Hamza , Peter Mark
Published: December 2022

Background

Acalculous cholecystitis (AC) is considered a life threatening inflammatory disorder of the gallbladder and is associated with high mortality and morbidity. Although it has been classically reported in critically ill patients with sepsis, trauma, burns and major surgery, AC has also been described in outpatient settings. This study aims to review the clinical presentation of AC in a busy district general hospital.

Methods

Consecutive patients diagnosed with cholecystitis between March 2018 and March 2020 were identified from electronic medical database. Patients with no clinical/radiological signs of cholecystitis and confirmed gallstones on imaging were excluded. Data related to presenting symptoms, National Early Warning Score (NEWS), intensive care admission and AC related complications were retrospectively collected and analysed.

Results

In this two-year study period, 61 patients were diagnosed with AC. Only 4 patients were seen in an outpatient setting. The primary presenting complaint for all patients was abdominal pain. Initial clinical presentation had a range of severity. Thirty-seven patients had NEWS of 0–1, 20 patients with NEWS 2–4 and 4 patients had NEWS >4. One patient required intensive care and another was transferred to a tertiary unit. A total of 7 patients developed complications of AC; 4 gallbladder perforations, 2 emphysematous cholecystitis and 1 gangrenous cholecystitis. There was one mortality.

Conclusions

The study shows that majority of patients with AC were not critically ill. Having observed complications of AC in 11.7% of patients, this study highlights the need to have a high index of suspicion for AC in patients without coexisting critical illnesses as well.
HPB P57 Acalculous Cholecystitis – Does it need a redefinition?
Authors: Suresan Srutti , Shaukat Mubasher , Ahmad Reddin , BinSahl Abdullah , Naeem Hamza , Peter Mark
Published: December 2022

Background

Acalculous cholecystitis (AC) is a necroinflammatory disorder of the gallbladder in the absence of gallstones. AC is a diagnostic challenge due to absence of clear published diagnostic criteria. Though diagnosis is dependent upon radiological findings in combination with clinical findings and blood results, it can only be confirmed after analysis of operative findings and post-operative histology. This study aims to assess the correlation between pre-operative imaging and post-operative histology.

Methods

Data was retrospectively collected for all patients with a diagnosis of cholecystitis (March 2018 - March 2020) by reviewing ultrasound, computerised tomography and magnetic resonance cholangiopancreatography findings. Patients without any clinical/radiological signs of cholecystitis and with confirmed gallstones on imaging were excluded. A total of 61 patients were identified with AC.

Results

Twenty-one patients underwent cholecystectomy at time of data collection. Eleven patients had histological evidence of AC; histology results only showed acute/chronic cholecystitis. Out of these 11 patients, pre-operative imaging from at least one imaging modality showed biliary sludge/microlithiasis in 9 patients.

Overall, 13 patients did not have biliary sludge/microlithiasis on pre-operative imaging. Correlating histology results showed 2 patients with gallstones, 1 patient with cholesterolosis, 9 patients with acute/chronic cholecystitis alone and 1 normal gallbladder. Among the 8 patients with biliary sludge/microlithiasis on imaging, histology results identified 1 patient with gallstones, 5 patients with cholesterolosis and 2 patients with acute/chronic cholecystitis alone.

Conclusions

Given improvement in diagnostics in detecting biliary sludge, the classical definition of AC may no longer be valid. This study suggests that a new classification may be necessary.
HPB P58 Does percutaneous cholecystostomy timing in high anaesthetic risk patients impact on outcome?
Authors: Khalid Ayesha , Hamid Mohammed , Parmar Jitesh
Published: December 2022

Background

Little is known as to whether early percutaneous cholecystostomy (PCT) is favourable to patient outcome in the acute setting compared to delayed PCT placement. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 hours) vs. delayed PCT over a six year period.

Methods

A retrospective observational study investigating patients who required a PCT at a single Trust in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience. Clinical outcomes, hospital statistics and details of any subsequent surgery were analysed using multivariate logistic regression models

adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade.

Results

There were 72 patients; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65–83) years, 52.8% were female, and 51.4% were classed ASA ≥3 with 94% scoring CCI >2. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p =0.044), improved definitive treatment (OR 6.26, p =0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p =0.004) with fewer patients bridging to emergency open surgery (OR 0.19, p =0.024).

Conclusions

Clinical outcomes may be superior in early PCT for high anaesthetic-risk patients following acute biliary sepsis but uncertainty remains. High quality prospective data are required to determine the effects of PCT timing on clinical outcomes and hospital statistics.
OGC P02 A comparison of body composition changes between the FLOT and MAGIC regimes in patients with locally advanced oesophageal cancer
Authors: Liew Mei Sien , Almonib Ahmed , Al-Najjar Yousif , Siddaiah-Subramanya Manjunath , Tan Benjamin
Published: December 2022

Background

Recently, peri-operative FLOT (fluorouracil plus leucovorin, oxaliplatin, and docetaxel) chemotherapy has superseded the ‘MAGIC’ regimen (epirubicin, cisplatin plus fluorouracil or capecitabine) as standard of care for locally advanced oesophago-gastric adenocarcinoma. However, concerns have been raised regarding the toxicity profile of FLOT. This study aims to compare the changes in body composition between both regimens.

Methods

115 patients treated with FLOT (n = 61) or MAGIC (n = 54) who underwent an oesophagectomy for oesophageal or gastro-oesophageal junction (GOJ) adenocarcinoma between 2014 and 2020 at Queen Elizabeth Hospital, Birmingham, UK were analysed. Changes in body composition between pre- and post-neo-adjuvant chemotherapy were determined by analysis of computed tomography imaging.

Results

In both regimes, a large proportion of patients were sarcopenic prior to starting chemotherapy (FLOT 44.2%, MAGIC 44.4%; p=0.984). The percentage of patients who were sarcopenic increased post chemotherapy (FLOT 63.9%, MAGIC 57.4%; p=0.474). There was no significant pre vs post chemotherapy change in L3 skeletal muscle index in both regimes (FLOT 2.96 ± 4.03 vs MAGIC 2.76 ± 4.21; p=0.792). There was also no significant pre vs post chemotherapy change in L3 fat index in both regimes (FLOT 2.49 ± 22.6 vs MAGIC 5.78 ± 24.2; p = 0.453). Myosteatosis was observed in 44.3% of patients pre-FLOT and 42.6% of patients pre-MAGIC (p=0.857). This increased to 62.2% post-FLOT and 46.3% post-MAGIC (p=0.085). FLOT chemotherapy was associated with better tumour regression grade compared to MAGIC (p<0.001).

Conclusions

A large proportion of patients with locally advanced oesophageal/GOJ adenocarcinoma were sarcopenic and had myosteatosis prior to starting chemotherapy. A further loss of muscle and fat occurs during chemotherapy but there was no significant difference in loss of fat or muscle across both FLOT and MAGIC regimes. However, patients treated with the FLOT regime had better pathological response as compared with MAGIC.
OGC P10 Stage Migration, Changed Treatment Profile and Survival Impact in Newly Diagnosed Oesophago-gastric Cancer in Scotland during the COVID-19 Pandemic – A National study
Authors: Khan Khurram , Baxter Mark , Gall Lewis , Samuelson Catherine , Narramneni Lakshmi , Al-Zuabi Manaf , Bryce Gavin , Shareef Hala , Petty Russell , Forshaw Matthew
Published: December 2022

Background

COVID-19 has significantly disrupted cancer care. This may have impacted on staging, management and survival as health services worldwide had to adapt. Responding to the pandemic, the UK government declared a national lockdown on 23rd March 2020.

This national study investigated the effect of the national response on oesophago-gastric (OG) cancers in Scotland, including time from referral to gastroscopy, staging at presentation, multidisciplinary team (MDT) treatment outcomes and overall survival.

Methods

This was a retrospective cohort study. Consecutive new patients presenting in NHS Scotland to five regional OG cancer MDTs covering 93.2% of the Scottish population between October 2019 and September 2020 were identified. Electronic health records were reviewed. The study period was divided into pre- and post-lockdown, based on the first UK national lockdown.

Results

931 patients with biopsy-proven OG cancer were identified; 499 (53.6%) pre- and 432 (46.4%) post-lockdown. Median age was 71 years (range 25–95) and 66% were male. There were 252 (27.1%) gastric and 679 (72.9%) oesophageal cancers. No clinically meaningful difference in median time to gastroscopy was observed post-lockdown (19 days vs 15 days, P<0.001), however, patients were more likely to present as an emergency (11.1% vs 8.2%, p=0.014). Post-lockdown, patients tended to poorer ECOG PS (p=0.09), were more symptomatic (p=0.007), and presented with higher stage disease (stage 4; 57.6% vs 49.3%). There was a significant shift to palliative intent treatment post-lockdown (76.2% vs 64.7%, p<0.001). Median overall survival post-lockdown was 7.6 months vs 10.1 months pre-lockdown (HR 1.24; 95% CI 1.06–1.43, p=0.005).

Conclusions

This national study highlights the impact of COVID-19 on OG cancer diagnosis and outcome in Scotland. Patients presented at a later stage and a shift towards palliative intent treatment was observed, with subsequent negative impact on overall survival. The reason for the observed stage migration of OG cancers is likely multifactorial, occurring prior to the diagnostic pathway and not simply due to a delay in performing gastroscopy.
OGC P21 EZH2: A novel therapeutic target in oesophageal adenocarcinoma
Authors: Pickering Oliver , Harrington Jack , Breininger Stella , Sharpe Ben , Underwood Tim , Walters Zoë
Published: December 2022

Background

Enhancer of zeste homologue 2 (EZH2), the catalytic subunit of the histone lysine methyltransferase Polycomb Repressor Complex 2 (PRC2), mediates gene silencing of target genes epigenetically. It is over-expressed and associated with poor outcomes in numerous malignancies. EZH2 inhibitors are currently used in the treatment of follicular lymphomas and epithelioid sarcomas. Oesophageal adenocarcinoma (OAC) has predicted sensitivity to EZH2 inhibition due to the high prevalence of potentially sensitizing mutations. This in vitro study aimed to assess the efficacy of EZH2 inhibitors in the treatment of OAC.

Methods

Bioinformatical analysis of publicly available bulk RNA transcriptomic data from OAC samples included in the Cancer Genome Atlas (TCGA) database was carried out. OAC cell lines OE33, FLO1 and MFD1 cultured in 2D were treated with a panel of EZH2 inhibitors at a range of clinically relevant concentrations either as monotherapies or in combination with OAC standard of care (SOC) chemotherapies. Cell viability was assessed via colorimetric MTS assay at 72hrs and 6 days post-treatment.

Results

Median EZH2 mRNA expression levels calculated from OAC TCGA data were significantly greater than EZH2 mRNA expression in normal oesophageal tissue (p<0.01). OAC patients with high EZH2 expression had reduced median overall survival compared to patients with low EZH2 expression (13.1 months vs 32 months, p= 0.03). EZH2 inhibitors demonstrated efficacy as monotherapies in all 3 cell lines. EZH2 inhibitors in combination with 5-fluorouracil (5-FU) showed greater efficacy than 5-FU alone, demonstrated by reductions in 5-FU half-maximal inhibitory concentration (IC50) values.

Conclusions

These early in vitro results demonstrate the potential of EZH2 inhibition as a novel therapy in OAC, particularly in combination with current chemotherapy agents. Further in vitro work is focused on their efficacy in patient derived tumour organoid models.
OGC P24 The effect of the pandemic on the number of examined lymph nodes following major oesophophagogastric resection
Authors: Youssef Fady , Jackson Andrew , Hossain Tanvir , Trotter Martin , Yanni Fady , Parsons Simon L
Published: December 2022

Background

Lymph node yield following oesophagogastric (OG) cancer resection remains a valuable prognosticator of overall patient survival. It is also a quality indicator of histopathological assessment and a surrogate marker of surgical technique. The Royal College of Pathologists’ state a minimum lymph node yield of 15 per specimen should obtained in 100% of cases where a radical OG resection has been undertaken. It is well known that the COVID-19 pandemic placed immense strain on NHS services. This study aimed to evaluate its effect on lymph node yield reporting following major OG resection in a large volume tertiary unit.

Methods

Retrospective National OG Cancer Audit (NOGCA) metrics were collected. Histological data including total lymph node yield and positive node status were extracted from patient records. Patient data was categorised into two study periods; pre-pandemic (March 2018-Feb 2020) and pandemic (March 2020- Feb 2022) following the first UK national lockdown. Comparative analysis between the two study periods was performed and for lymph node yield >15 per specimen a X2 statistic calculated.

Results

In the pre COVID period a total of 280 (excluding GIST) resections were performed, 75% (210) oesophagectomies v. 25% (70) gastrectomies. The median age was 69 (range 25–90, males= 189 v. females =91). In the post pandemic period a total of 188 resections were performed, 72% (135) oesophagectomies v. 28% (53) gastrectomies. The median age was 69 (38–87, males = 142 v. female= 46). Lymph node yield was available for 275 resections in pre-pandemic study period, with a median nodal yield of 20 (5–61). In the pandemic study period lymph node yield data was available for 180 patients, median 19.5 (0–69). The minimum nodal yield (>15) was obtained in 80.7% of resection specimens pre-pandemic v. 68.9% in the pandemic study period (p= 0.00382).

Conclusions

Our study demonstrates a higher rate of inadequate nodes examined in the post pandemic study period. Despite staffing pressures, efforts should be made to improve number of nodes examined to provide robust prognostic data.