bluuebunny/crossref_metadata_2025 huggingface dataset:
A05 - HPB Interrogating the spatial biology of pancreatic cancer-associated fibroblasts
Authors: Bryce Adam , Dreyer Stephan , Froeling Fieke , Martinelli Silvia , Pennie Rachel , Officer-Jones Leah , Le Quesne John , Chang David
Published: November 2024

Background

Cancer-associated fibroblasts (CAFs) are key players in the fibrotic tumour microenvironment (TME) of pancreatic cancer. Recent evidence has demonstrated the existence of multiple CAF subtypes, however there is relatively little evidence validating and corroborating these CAF subtypes in resected human pancreatic cancer. Furthermore, the spatial interactions between CAF subtypes and the epithelial and immune compartments of the pancreatic cancer TME is not well understood.

Method

We designed and optimised a bespoke 8-plex immunofluorescence panel for the purposes of CAF subtype profiling and elucidation of CAF spatial biology: panCK, FAP, SMA, CTGF, S100A4, IL6, LIF, PDGFR. This was applied to a cohort of n=215 resected pancreatic cancer, well characterised with highly granular clinico-pathological and transcriptomic data through the Australian Pancreatic Cancer Genome Initiative. Spatial analysis was performed with novel computational biology techniques.

Results

We demonstrate seven CAF subtypes which cluster to form distinct, highly prognostic “enrichment profiles” (EPs). The cold EP represents quiescent CAFs in close proximity to immune cells (multivariate HR 0.45, 95% CI 0.30-0.68, p<0.001), and the fibrotic EP represents activated CAFs in close proximity to epithelial cells (multivariate HR 2.22, 95% CI 1.48-3.35, p<0.001). We also demonstrate the prognostic power of high spatial entropy (loss of tissue architecture, correlating with the fibrotic EP) vs low spatial entropy (preservation of tissue architecture, correlating with the cold EP) (HR 2.22, 95% CI 1.47-3.35, p<0.001).

Conclusion

We begin to unravel the elusive spatial biology of pancreatic CAFs in a large resected human cohort. We see changes in immune cell infiltrate, modulation of cellular relationships, and greater tissue disorganisation as a result of CAF activation. These features are highly prognostic and we hypothesise they are driven by changes in crosstalk between TME compartments. Current work focuses on application of these techniques to a large resected neoadjuvantly-treated cohort, allowing further interrogation of the notorious fibrotic post-neoadjuvant pancreatic cancer TME. If accepted for presentation we look forward to presenting both cohorts simultaneously.
HPB O02 - On-site hepatobiliary surgery capability independently predicts treatment pathway completion in metastatic rectal cancer: A nationwide observational study of 15,727 patients
Authors: Lakha Adil S , Chammas Lara , Morris Eva , Gordon-Weeks Alex
Published: November 2024

Background

Stage IV rectal cancer carries a 10% 5-year survival rate (Jemal et al., 2005). Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion.

Method

Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), radiotherapy datasets (RTDS), and Hospital Episode Statistics (HES) data. Treatment pathway completion was defined as receipt of intervention to the primary tumour, in addition to metastasis-directed therapy, or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion.

Results

A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. There was significant variation in proportion of patients with complete treatment between MDTs. Multivariable analyses showed that lack of on-site HPB surgery capability was the only predictor of failure to complete treatment (OR 1.22, 95%CI:1.07-1.38, p<0.01).

Conclusion

Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between cancer alliances or whether they are due to differences in MDT decision making.
MS O09 - OGC Long-term oncological outcomes following totally minimally invasive, hybrid and open oesophagectomy for cancer
Authors: Sadik Wafia , Waheed Unaiza , Alkhaffaf Bilal
Published: November 2024

Background

There has been a significant shift in the surgical management of oesophageal cancer, with increased popularity of minimally invasive oesophagectomy in comparison to open approaches. Data thus far has largely focused on the peri-operative and short-term benefits with limited study on long-term oncological outcomes. This study aims to explore patterns of oesophageal cancer recurrence and survival following minimally invasive and open oesophagectomy.

Method

This was a retrospective review of consecutive patients who underwent open (OO), hybrid (HO) and minimally invasive (MIO) oesophagectomy for cancer at a regional oesophago-gastric centre in the UK between 2014-2023. Follow-up data was obtained from the centre’s established surgical database, in addition to the regional radiology, MDT and electronic patient records to record survival, recurrence, and patterns of recurrence (locoregional, haematological, distal nodal, peritoneal and number of recurrence sites).

Results

437 patients (170 OO; 132 HO; 135 MIO) were included. There was no difference in baseline data between the groups. Overall survival rates at 1-, 3-, and 5-year were 88%, 64% and 54%. Recurrence rates at 1-, 3-, and 5-year were 17%, 35% and 41%. Haematological and locoregional recurrence made up 37% and 33% of all recurrence types. 52% of patients had one type of recurrence at diagnosis. After adjusting for disease stage, there was no significant difference between operative approaches with respect to survival and recurrence rates (at 1,3 and 5 years), time to recurrence, or patterns of recurrence.

Conclusion

This study found no significant difference in long-term oncological outcomes when comparing different minimally invasive and open surgical approaches to oesophagectomy. MIO can continue to be offered to patients as a safe alternative to open surgery. Further multi-centre prospective research is required to validate these results.
VS 02 - HPB Inter-fascial Catheter with Local Anaesthetic Infusion in Hepato-biliary Surgery (HILA) – A Video Guide to Catheter Placement
Authors: Sellappan Hari , Charles Nina , Adiamah Alfred , Eastwood Joanne , Sanyal Sudip
Published: November 2024

Background

Thoracic epidural analgesia (TEA) offers effective pain control after open hepato-biliary surgery, however it is associated with several limitations that delay post-operative recovery. Inter-fascial catheter with local anaesthetic infusion (IF) is an effective, safe and cost-saving alternative to thoracic epidural analgesia (TEA) following open liver and biliary surgery, with significant decrease in post-operative vasopressor requirements, and length of critical care and hospital stay.

Method

This video presentation outlines current clinical evidence with local data from Nottingham University Hospital, relevant clinical anatomy of the inter-fascial plane, intra-operative placement techniques, tips and tricks as well as troubleshooting in the event of a catheter related complication.

Results

The inter-fascial catheters can be placed in the transversus abdominis or posterior rectus plane based on the type of skin incision to achieve optimal post-operative pain control. It is associated with a low technical failure rate.

Conclusion

Inter-fascial catheter with local anaesthetic infusion is an effective, safe and cost-saving technique associated with significant decrease in post-operative vasopressor requirement, and length of critical care and hospital stay.
VS 04 - HPB Laparoscopic trans-vesical approach is safe management for cholecystoduodenal fistula
Authors: Bakewell Zoe , Thiagarajah Viswan , Bright Euan , Zino Samer
Published: November 2024

Background

A 71 year old female initially presented cholangitis. Her MRCP showed a distal common bile duct (CBD) stone. An ERCP was then performed which was not successful due to anatomical challenge in the form of a large diaphragmatic hernia. An elective laparoscopic cholecystectomy with IOC was performed. An incidental cholecystoduodenal fistula was found therefore the clinical decision was made to perform a trans-vesical approach to fistulogram. This showed a fistula was present and that it was not complicated further. This case shows that this approach avoided iatrogenic injury by confirming presence of the fistula and aided further surgical planning.

Method

Standard four-port technique with 10mm, 30-degree laparoscope. Blunt, sharp, energised and hydro-dissection were employed. The duodenum was adherent to the gallbladder body therefore a trans-vesical enterotomy was performed. Fistulogram confirmed presence of a cholecystoduodenal fistula but nil further pathology. The fistula was dissected from the gallbladder and stapled with the GIA endo- tri-staple 45 Purple. Further dissection to gallbladder to ensure clear visualisation of calot’s triangle. Basket trawl of the CBD was performed and repeat cholangiogram was clear. The gallbladder was dissected from gallbladder fossa, all gallstones were removed and 3L of wash was used to irrigate the intra-abdominal cavity.

Results

The patient was admitted following the procedure and was discharged on day two with PPI. She was reviewed post-operatively at 12 weeks and had no further issues. She remains well and has had no further episodes of cholangitis or hospital admissions in almost four years since the procedure.

Conclusion

This case shows an unexpected finding of cholecystoduodenal fistula in a planned laparoscopic cholecystectomy with IOC. It is important to note that some gas was seen in the gallbladder on initial imaging therefore indicating a possible cholecystoduodenal fistula. This trans-vesical approach with fistulogram confirmed a simple fistula and no further pathology and aided safe surgical planning. This improved patient outcomes and avoided iatrogenic injury thus providing a safer way to manage cholecystoenteric fistula. This novel approach to cholecystoduodenal fistula repair improves patient safety, length of stay and by aiding intra-operative planning and avoiding iatrogenic injury.
AHP SO02 - A Quality improvement project to improve the Nutritional teaching within the General Surgery Department
Authors: Walton Chelsea , Finn Megan , Hill Anna
Published: November 2024

Background

Malnourished patients have greater incidences of post operative complications which can prolong hospital stay. Dietitians improve the nutritional status peri-operatively to reduce complications and accelerate recovery in hospital. Given that the doctors working in surgery are junior doctors who work on a rotational basis, means that they have little time to get to know the roles of the MDT, hence they are faced with the challenge of having little knowledge of complex nutritional needs of the surgical patient.

The aim of the quality improvement project is to improve the nutritional teaching within the General surgery department to improve clinical practice.

Method

Using Plan-do-study-act (PDSA) Methodology, a Multi-disciplinary-team was created to identify ways to improve our nutritional knowledge. An initial survey was collated and distributed throughout the department to establish the current knowledge of nutritional challenges. From the initial survey, a need to improve the teaching of nutrition to the department was highlighted.

The plan implemented itself in the form of informal teaching and educational resources to provide teaching to the department. Further questionnaires were used to assess the value of the teaching sessions. Pre/Post-teaching session surveys were used to assess the participant progress and satisfaction of the teaching session.

Results

The initial survey showed that on average the individuals sampled had a neutral/basic knowledge of the nutritional topics.

In addition the survey addressed a need for surgical nutritional teaching to which 100% of respondents answered ‘Yes’. 100% of the respondents gave a 7/10 above or higher rating for how much they would benefit from the teaching and 100% of the cohort either requested teaching sessions alone or both a teaching session and information booklet.

Following these interventions; a Pre/ Post-teaching survey was conducted to provide insight of how the department responded to the teaching, which was overall well received.

Conclusion

The role of nutrition is an important factor that affects surgical outcome and having clinical knowledge of nutritional needs and complications allows us to improve our clinical practice and patient care. The project identified a need for educational improvement and the project has allowed the department to establish regular quarterly nutritional teaching for rotational training and provided educational resources that have been demonstrated to be an effective intervention within the department. The project provided an overall positive engagement to improve our nutritional knowledge and will undoubtedly have a marked impact on quality of care, patient outcomes and their experience.
AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer
Authors: White Cathy , Arumugasamy Mayilone , Robb William
Published: November 2024

Background

Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer.

Method

A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included.

Results

63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m.

Conclusion

In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.
AHP SO10 - A review of preoperative dietetic outcomes in patients with oesophagogastric (OG) cancer undergoing surgery
Authors: Hegarty Jane , Mak HiuKei , O' Neill Aoife , Henggeler Cordula , Evans Orla
Published: November 2024

Background

In line with NICE guidance (2018), all patients undergoing OG surgery at GSTT are offered a dietetic assessment by a specialist dietitian before their surgery. There is emerging evidence and interest in prehabilitation programmes to improve clinical and patient-centred outcomes. Nutritional optimisation is a key component of such programmes, although the optimal nutrition interventions are not fully elucidated, particularly within the preoperative period (Casey et al., 23). There is large national variation in dietetic interventions and minimal guidance on best practice to support this patient group.

Method

A retrospective review was undertaken to assess whether preoperative dietetic goals for patients with OG cancer undergoing surgery between August 2022 to January 2023 were achieved. Outcomes based on weight were reviewed given its routine use and availability. Dietetic goals were categorised according to the following aims: weight gain, weight stability and weight loss. Data was collected on 44 patients and excluded from analysis were those who were not assessed by a dietitian preoperatively. The length of intervention was defined in days.

Results

Table 1.0 Goal Weight Gain (n=11) (all ONS) Intervention length Achieved (>1kg weight gain) 7 (64%) 19-46 Not achieved (<1kg weight gain/ weight loss) 4 (36%) 26-40

Conclusion

Overall, 52% patients did not achieve their weight goal before surgery. At present in our centre, patients receive one appointment with the specialist dietitian before their surgery due to limited resource. There is a recognition that additional support is required for many patients to prepare for surgery. Prehabilitation would address this and have the potential to improve dietetic outcomes. Weight is a readily available outcome measure but does not reflect body composition or other parameters of nutritional status. More comprehensive assessment of nutritional status would support further evaluation of dietetic outcomes and their impact on clinical and patient centred outcomes.
BS SO03 - Revisional bariatric surgery following sleeve gastrectomy, a meta-analysis comparing RYGB and OAGB
Authors: Santoro Giovanni
Published: November 2024

Background

The number of bariatric operations is on the rise each year. Sleeve gastrectomy is the most popular procedure however often requires a revision surgery because of insufficient weight loss, weight regain or GERD. The most popular procedures are RYGB and OAGB. Our primary outcome was to look at the effect on weight loss in patients undergoing revision surgery and the secondary outcomes were gastro-oesophageal reflux, BMI difference, operative time, bleeding and anastomotic leak

Method

A systematic electronic search was undertaken using PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ according to PRISMA. Initial search identified 2,546 articles, after screening seven papers met the inclusions criteria, six retrospective studies and one RCT.

Results

There were a total of 802 patients that fit the inclusion criteria. 390 patients had a OAGB and another 412 had a RYBG. All patients previously had sleeve gastrectomy for weight loss. The length of follow-up was 12 months for our primary outcome. We found no statistically significant difference in %EWL between OAGB and RYGB (p=0.11). The incidence of post-operative reflux was statistically significantly higher in the OAGB group (16% vs 10.1%, p<0.003). Operative time was statistically significantly lower in the OAGB group (p=0.04).

Conclusion

Our meta-analysis showed no statistically significant difference between the two revision bariatric surgery procedure for %EWL. RYGB was superior to OAGB in reducing the incidence of symptomatic GERD while OAGB had a significant shorter operative time.
BS SO09 - Use of ursodeoxycholic acid in preventing gallstone formation after bariatric surgery – introduction of a new clinical pathway
Authors: Cromwell Paul , Gopalan Vignesh , Ayliffe-Daly Lucie , Welbourn Richard
Published: November 2024

Background

Rapid weight loss is a risk factor for symptomatic gallstone formation. Managing gallstone disease such as choledocholithiasis can be more challenging after Bariatric Surgery (BS) due to altered anatomy. Ursodeoxycholic acid (UDCA) is a low-cost and low-risk method of reducing the risk of symptomatic gallstone disease and cholecystectomy by almost a third in patients who have had BS. However, it is not yet included in national guidelines for bariatric surgery. We audited prescription rates of UDCA in patients who underwent BS with a view to introducing it into our standard post BS care bundle.

Method

Data was collected from 30 consecutive patients who underwent a sleeve gastrectomy or Gastric bypass in November and December 2023. The results informed our practice and a UDCA prescribing pathway was developed using evidence from randomized trials. The pathway was circulated to all members of the bariatric service on 17/1/2024 and discussed at the departmental meeting. The audit loop was closed by collecting data from a further 30 consecutive patients. Demographic data, type of operation, BMI, history of gallstone disease, prescribing data and reasons for non-compliance were collected. The compliance rate to the UCDA pathway was expected to be 100%.

Results

Data was collected from 60 patients (85% female; median BMI 49; median age 45). No patient who could have benefited received UDCA prior to the intervention. After the intervention, 15/30 (50%) of patients were correctly prescribed UDCA. Therefore, correct prescription of UDCA did not meet target compliance rates. No patient was incorrectly prescribed UCDA. Reasons for non-compliance include human error, concern about the size of the tablet, inadequate knowledge about how to administer (e.g. crushing in liquid) and misconceptions of oral intake after BS.

Conclusion

UCDA can reduce incidence of symptomatic gallstones following BS, yet use of UDCA in bariatric centres in the UK is thought to be low. We discovered that more time should be dedicated to educating the team about administration methods and how it interacts with the current postoperative diet plan. A UCDA pathway and education of bariatric teams can improve compliance with appropriate UDCA prescribing. Further intervention is required and planned in our centre such as utilising e-prescribing as a prompt to include UDCA in the discharge prescription and considering the use of the drug's liquid form in the short term.
BS SO13 - Reversal of OAGB- Audit and steps of surgery
Authors: Kaur Mandeep , Haider Ijlal
Published: November 2024

Background

OAGB is a well-established procedure that gives good outcomes in terms of benefits from obesity related morbidity and weight loss. The nutritional complications of OAGB are not common. The most common complication for OAGB is bile reflux which can be controlled with medical or surgical management.

The need to convert OAGB to normal anatomy or sleeve does not arise frequently. It is needed in a few patients. It is a technically challenging procedure and should be done in expert centers

Method

We would like to present a video on the steps of reversal surgery. We recorded our procedure and used imovies software to edit it demonstrating each step of surgery with a written commentary for ease of understanding

We would also take this opportunity to present an audit of our series of patients. We gathered our operative sheets from December 2016- Jan 2024. There were 12 patients who needed conversion or reversal. 10 needed conversion to RYGB for bile reflux. 2 needed reversal to normal anatomy.

Results

High quality video presentation with narration talking about steps of surgery and results from our audit

Conclusion

Reversal surgery is a technically challenging procedure. It should be done in expert center. Also, since this surgery is not needed frequently, it needs expert surgeons.
EGS SO03 - Audit of wound complications after Emergency laparotomies in A University Teaching Hospital: 2-cycle Prospective Audit
Authors: Awad Philobater , Hassan Basma
Published: November 2024

Background

Wound infections and incisional hernias are frequent complications that can occur after an emergency laparotomy. The surgical technique used plays a crucial role in determining the likelihood of complications. The objective of this audit was to evaluate our technique in performing emergency midline incision closure and to compare our complication rates with those of established guidelines.

Method

A two-year prospective audit, comprising two cycles, was conducted at a teaching university hospital to evaluate the incidence of wound infections following emergency laparotomy. During each cycle, which lasted for one year, 1423 patients underwent an emergency laparotomy.

Results

The initial outcomes showed that wound infection rate was 123 out of 621, which translates to 19.8%, the overall rate of acute fascial rupture was 66 out of 621, amounting to 10.6%, while overall incisional hernia rate was 87 out of 621, which equals 14%.

In the subsequent cycle, wound infection rate was 49 out of 802, corresponding to a percentage of 6.2%. The overall rate of acute fascial rupture was 34 out of 802, which is equivalent to a percentage of 4.3%, while the overall incisional hernia rate was 42 out of 802, which translates to 5.2%.

Conclusion

In conclusion, the audit revealed several areas of improvement to address in order to enhance its overall performance and achieve its goals of decreasing our rate of wound complications after urgent laparotomy which needs our adherence to this closure technique
EGS SO07 - Laparoscopic retrieval of endoscopic lithotripsy basket aided by laser fragmentation: Case presentation and literature review
Authors: Nip Lawrence , Lynch Mark , Philipose Zinu , Ceraldi Serena Sabato
Published: November 2024

Background

Large or impacted common bile duct (CBD) stones that cannot be removed by conventional endoscopic methods sometimes require endoscopic mechanical lithotripsy. A rare but feared technical complication related to this is basket entrapment, where the stone-basket complex cannot be separated from each other due to mechanical failure and becomes impacted within the CBD. We present a novel case of laparoscopic CBD exploration and antegrade laser fragmentation of impacted stone-basket complex, and perform a literature review pertaining to this topic.

Method

This is a case report from a single district general hospital with laparoscopic capabilities but no access to Spyglass. The operation began with fundus first subtotal cholecystectomy and the cystic duct was ligated with PDS endoloops. A choledochotomy was made and dilated to allow insertion of a 7.5 Fr cholangioscope. Through this, laser lithotripsy was undertaken which reduced the stone size and permitted disengagement of the stone from basket. The stone was retrieved via enlargement of the choledochotomy, while the basket and wire retrieved orally. We subsequently performed a literature review of Pubmed, Google Scholar, and Embase.

Results

Laparoscopic retrieval of an impacted basket was first described in 1993, with the basket found lodged in the gallbladder. The technique involved a large cholecystotomy, followed by removal of the basket, closure of the gallbladder, and then cholecystectomy. Our literature review yielded 5 case reports of laparoscopic retrieval of basket from the CBD. Three authors describe manual disengagement of the basket by laparoscopic manipulation of the wires, one describes capturing an impacted Dormia basket with a second Dormia basket, and one describes direct mechanical fragmentation and subsequent balloon trawl of the remaining debris.

Conclusion

To our knowledge, this is the first case report describing laparoscopic CBD exploration with concurrent laser fragmentation to facilitate retrieval of impacted stone-basket complex following mechanical lithotripsy failure. We propose that this is a viable option in centres without Spyglass or electrohydraulic lithotripsy, but where expertise for emergency laparoscopic CBD exploration exists.
EGS SO13 - Evaluation of Different Surgical Risk Prediction Models in Predicting Morbidity and Mortality in Giant Hiatus and Diaphragmatic Hernia Repairs
Authors: AlAsmar Mohamed , Al Aaraj Mahmoud , Alwani Omneya , Embaby Abdalrahman , Moore Eleanor , McKechnie Iona , Chaparala Ram
Published: November 2024

Background

Emergency giant hiatus hernia and diaphragmatic hernia repairs are associated with high rates of mortality and morbidity; different studies reported variable outcomes. Accurate risk assessment empowers patients to provide informed consent and also serves as a valuable tool for identifying individuals who may require enhanced postoperative care, such as respiratory support and critical care admission. Various risk prediction tools have been developed to assist clinicians in making decisions to aid in stratifying the risk of surgical management. We aimed to assess the effectiveness of different risk prediction models in predicting mortality and morbidity in this patient cohort.

Method

Retrospective analysis performed on cases between May, 2010 and January, 2021 in a tertiary adult upper gastro-intestinal centre. The outcomes from the operations were assessed and compared with the predicted morbidity and mortality for different risk prediction models. Including the Surgical Outcome Risk Tool (SORT), the National Emergency Laparotomy Audit (NELA), parsimonious NELA and the American College of Surgeons National Surgical Quality Improvement Programme (ACS-NSQIP). The models were compared using the area under the curve (AUC). Morbidity models included Portsmouth Physiological and Operative Severity Score (P-POSSUM) and the ACS-NSQIP. Morbidity was evaluated by calculating the comprehensive complication index (CCI).

Results

A total of 108 patients met the criteria and were included in the analysis. Among these 50.9% were females. The median age was 69 (IQR 59-78). The 30-day mortality rate was 6.93% (7 patients), six patients died during the same admission, and one patient died during a re-admission. ACS-NQSIP had the highest predictive power for mortality (AUC = 0.6344), in comparison to NELA (AUC=0.5665), parsimonious NELA (AUC=0.4866) and SORT (AUC = 0.4342). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho = 0.489, p<0.001 and 0.446, p<0.001 respectively).

Conclusion

ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, parsimonious NELA, P-POSSUM and SORT. Interestingly, parsimonious NELA had a lower prediction rate when compared with the older NELA model. ACS-NSQIP may have a role in pre-assessment and consenting of emergency hiatus and diaphragmatic hernia repairs. Multi-centre prospective studies could be used to validate these findings.
EGS SO21 - The undifferentiated general surgical take over 10 years: Emergency imaging
Authors: Hale Emily , Dean Lydia , Bowling Kirk
Published: November 2024

Background

The undifferentiated emergency general surgical take in July 2013 and July 2023, at a District General Hospital, was reviewed with the aim of understanding increasing pressures on the surgical and radiology departments, and subsequently identifying areas in which we could adapt to facilitate these demands.

Method

Patients were identified retrospectively if they had been cared for by the emergency general surgical team in July 2013 or July 2023. Further information was collected from electronic notes, with a focus on admission and initial imaging modalities. Patients were excluded if information was not available electronically.

Results

Of the 395 patients in July 2013, and 594 in July 2023, 55% and 61% respectively had imaging studies within 7 days of admission. 11% (n=44/395) of patients in 2013 had abdominal X-ray without further imaging, compared to 6% (n=33/594) in 2023. Computed Tomography (CT) use increased by 35%, whilst ultrasound scanning (USS) increased only by 11%. Time from admission to scans of all types has reduced from 0.79 days (+/-0.16, p=0.02) in 2013 to 0.60 (+/-0.1, p=0.02) days in 2023.

Conclusion

Overall volume of imaging has increased slightly, although the proportion of patients being scanned is largely unchanged, with subtle variation in preferred imaging modalities. CT is marginally more common, whilst USS remains mostly unchanged. The use of abdominal x-ray without subsequent imaging has decreased, demonstrating its reducing use in clinical judgement and reliance on alternative imaging techniques. Time from admission to scan of all kinds has reduced, despite increasing demands on radiology departments.
EGS SO31 - Does in-hospital delay in appendicectomy lead to complicated appendicitis and affect post operative outcome - a single centre study
Authors: Singh Gautam , Sonde Sarah , Guest Megan , Astbury Lauren , Gupta Ankit , Hamson George , Brown Daniel , Raheel Muhammad , Morrison Charles , Sarkar Rupa
Published: November 2024

Background

Acute appendicitis is one of the most common reasons for emergency general surgical admissions in the U.K. The standard treatment for acute appendicitis is emergency appendicectomy. However, the urgency to operate on patients admitted to hospital with acute appendicitis has been widely debated, with no current standard guideline to follow.

The aim of this study was to identify the effect of in-hospital delay in appendicectomy on intra operative findings of complicated appendicitis. The secondary outcome measures were the requirement of a surgical drain, overall length of stay, post-operative complications and re-admission rates.

Method

This was a single centre retrospective study. All patients who underwent an emergency appendicectomy, between 01/09/2023 and 30/11/2023 were included in this study. Hospital electronic patient records were screened to record the time of decision to operate, surgical start time, the delay between decision to operate and surgical start, intra-operative findings, and post-operative course.

A total of 105 patients were included. These were divided into two sub-groups based on the delay between decision to operate and surgical start time; patients who had surgery within 12-hours (early) and those who had surgery after 12-hours (delayed) from the decision to operate time.

Results

Surgery was performed within 12-hours in 42% cases. The remaining 68% had more than a 12-hour delay, with almost 1 in 4 cases (26 /105) delayed over 24 hours.

15% cases (16) with uncomplicated appearance on pre-op imaging and delayed more than 12-hours progressed to complicated appendicitis intra-operatively.

Surgical drains were required in 10% delayed cases and 6% early cases.

The median length of stay was 2-days in delayed, compared to 1 day in cases performed early.

Post-operative complications were higher in cases early. Although majority of these had complicated appearance in pre-op imaging.

Both groups had same readmission rate.

Conclusion

Our study found that in-hospital delay in appendicectomy can potentially result in increased length of stay, higher rate of requirement of surgical drains and progression from imaging severity. This needs better prioritisation and theatre allocation.
OGC SO04 - Impact of COVID-19 on Decision-making and Survival in Esophago-Gastric Cancer Treatment: Insights from a Multidisciplinary Approach
Authors: Alasmar Mohamed , Matias Nadia , Alhamed Norah Ali M , Alwani Omneya , Rudge Brogan , Moti Terngu David , Yassin Abdelwahab Mohamed Ossama , Stockton Jennifer , Raslan Charef , Cairney-Hill Jess , Altarawni Mohamed , Alkhaffaf Bilal
Published: November 2024

Background

The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods.

Method

A retrospective cohort study involving patients referred to a UK tertiary EG cancer center during distinct six-month intervals mirroring the pandemic's evolution. Analysis focused on MDT recommendations, treatment pathways, and two-year survival rates, comparing deviations from standard care across periods.

Results

The study revealed a significant reduction in patient referrals and expedited treatment decisions during the pandemic peak, with a shift towards palliative care in post-pandemic cases. Although no statistically significant difference in two-year survival rates was observed, the post-pandemic period showed an increase in tumor aggressiveness and positive resection margins, suggesting potential long-term impacts of delayed diagnosis and treatment.

Conclusion

COVID-19 has significantly influenced MDT decision-making and patient pathways in esophago-gastric cancer care, underlining the necessity of resilient healthcare systems. Despite maintaining survival rates, the observed increase in tumor aggressiveness post-pandemic highlights the critical need for uninterrupted cancer diagnosis and treatment services during global health emergencies.
OGC SO06 - Novel Non-metallic Fiducial marker for Radiotherapy in Oesophageal Cancer
Authors: Robinson Alexander , Abdul-Kader Nayaab , Ullah Faizan , Farhangmehr Neda , Jayanthi Venkatesh
Published: November 2024

Background

Early oesophageal tumours are technically difficult to delineate on the planning computed tomography (pCT) for Image Guided Radiotherapy (IGRT). We describe the use of a novel non-metallic fiducial marker for this purpose.

Method

Non-metallic fiducial marker (NFM) (BioXmark) was used in 17 patients from April 2021 to November 2022 for marking tumour site prior to radical or palliative radiotherapy. NFM was injected in the sub-mucosal plane using fluoroscopy under general anaesthesia, with the patient supine and using regular injection catheter and syringes. After the initial series, further modifications to the technique improved the injection and shortened operative time. These include left lateral positioning, an ultra-fine injection catheters and micro-dosing syringes. Feedback from the treating radiation oncologists was sought for all the patients.

Results

Injection was successful in all the patients. In the initial series before the modifications to the technique, often the marker was a larger than anticipated due to a combination of poor visibility when the patients were supine and use of larger bore injection catheters. Once the patient position was changed along with the changes in the injection catheters and the syringes, marking was very precise.

Conclusion

Previously used fiducial markers are gold based. While these were visible on pCTs, they are known to cause distortion along with being expensive and cumbersome to inject. In comparison, NFM is easy to inject without the artefacts seen with metallic markers. We refined the technique further by changing the patient’s position to left lateral which afforded a improved fluoroscopic visibility. Introducing finer injection catheters and micro-dosing syringes further led to usage of lesser volume and precise marking respectively. In summary we present a series of patients whose early oesophageal tumours were marked with a NFM aiding precise delivery of radiotherapy.
OGC SO12 - Extended Venous Thromboembolism Prophylaxis in Postoperative Oesophagogastric Cancer Patients: A Completed Audit
Authors: Kuan Jen Yee , Turner Paul , Pursnani Kishore , Ward Jeremy , Shetty Vinutha Daya
Published: November 2024

Background

Venous thromboembolism (VTE) is a life-threatening complication for cancer patients undergoing oesophagogastric surgery. The NICE recommends extending pharmacological VTE prophylaxis to 28 days for patients undergoing major abdominal cancer surgery. While the effectiveness of in-hospital VTE prophylaxis is well-documented, the optimal duration for postoperative VTE prophylaxis remains a subject of debate. This study aims to evaluate the prescribing compliance, effectiveness, and safety of extending VTE prophylaxis to 28 days following hospital discharge (HD), a policy adopted trust-wide since 2014.

Method

This is an 11-year retrospective study from July 2012-2022, followed by a complete audit cycle conducted between January 2023-2024. The study included all patients who underwent cardio-esophagectomy or gastrectomy for oesophagogastric cancers. Exclusion criteria comprised patients who died during the index admission, those who underwent benign oesophagogastric surgery or local excision of gastrointestinal stromal tumours (GIST), and patients with peripherally inserted central catheter (PICC) line-associated VTE. The primary outcome measured was the prescribing compliance of 28-day VTE prophylaxis post-hospital discharge. Secondary endpoints included the incidence of VTE and bleeding complications necessitating hospital readmission within 28 days of discharge.

Results

Our study included 582 patients, showing that post-2014, 423 out of 490 patients (86.3%) were discharged with 28-day VTE prophylaxis, compared to 13 out of 92 patients (14.1%) pre-2014, indicating a significant improvement (p<0.05). Only one patient (0.17%) developed VTE more than 28 days post-discharge, and no readmissions due to bleeding complications. In the subsequent audit, 63 out of 68 patients (92.6%) received the prophylaxis, further increasing prescribing compliance. Comparing the two periods, compliance improved from 86.3% to 92.6%, though not statistically significant (p=0.145). Overall, VTE incidence was minimised from 0.17% to 0%, with no readmissions due to bleeding complications.

Conclusion

Routine extended VTE prophylaxis for 28 days post-hospital discharge should be recommended for cancer patients undergoing oesophagogastric surgery. This practice has significantly improved prescribing compliance rates, reduced post-hospital discharge VTE incidence, and demonstrated safety, with no hospital readmissions due to bleeding complications.
OGC SO23 - Audit on Enhanced Recovery After Surgery (ERAS) in Oesophago-gastric Resections for Cancers
Authors: Merkouris Christos , Tokhi Ashraf , Barnes Simone , Parsons Simon L
Published: November 2024

Background

Enhanced Recovery After Surgery (ERAS) protocols, have been designed to guide clinicians in managing patients post-operatively, reducing hospital stay, complications and readmissions. Our trust’s ERAS protocol includes guidance on oral intake initiation, drain, catheter and epidural removal, investigation frequency, medications required on discharge and early mobilization. However, implementation of ERAS protocols in complex oncological surgery can be challenging, due to the multiple factors included and increasing complexity. We aimed to assess the compliance of ERAS implementation in a high volume resectional oesophago-gastric unit, and subsequent impact on morbidity.

Method

A retrospective review of all patients who underwent oesophago-gastric resections during March-April 2024 was performed. Patients were included if they completed an oesophagectomy, or subtotal/total gastrectomy resection for cancer. Electronic records and medical notes were reviewed and compared to all aspects of the trust’s ERAS protocol. The adherence percentage to the protocol was calculated.

Results

20 patients underwent surgery. 85% started their oral diet on time per ERAS protocol. Adherence to ERAS was lowest for epidural (52.6%, 95% within 24-hours of target), catheter (55%, 90% within 24-hours of target), apical (55.6%, 100% within 24-hours of target), basal (53.8%, 85.7% within 24-hours of target), and abdominal drain removals (81.8%, 90.9% within 24-hours of target). All patients mobilized within four days post-op, with 65% achieving daily mobilization. VTE prophylaxis was prescribed for all, and discharge medication adherence ranged from 86.7% to 100%. The mean hospital stay was 9 days post-oesophagectomy, with a 3.2% emergency department return rate.

Conclusion

Implementation of an ERAS protocol is feasible in complex oesophago-gastric cancer surgery. Effective involvement and training of allied health, specialist pain services and the whole surgical team can decrease morbidity and length of stay in oesophagectomy, while avoiding excess emergency department presentations. Ongoing training and feedback of allied health, pain services, and surgical team at all levels is important to ensure adequate compliance.
OGC SO28 - Predictors of Pulmonary Complications Following Thoracoscopic Oesophagectomy
Authors: Ng Jessica Yan-Seen , Chmelo Jakub , Immanuel Arul
Published: November 2024

Background

Thoracoscopic oesophagectomy, a minimally invasive technique, is associated with less postoperative pain and reduced pulmonary dysfunction. There is a correlation between preoperative cardiopulmonary fitness and postoperative outcomes, with certain variables linked to a higher risk of complications following oesophagogastric cancer surgery. This review aims to identify variables that correlate with pulmonary complications after oesophagectomy.

Method

A retrospective review of patients undergoing thoracoscopic oesophagectomy between 2014 -2022 at a single oesophagogastric unit was performed. 96 patients were identified and separated into two groups (19 with serious complications (SC) (greater than Clavien Dindo 3b), and 77 without serious complications (Clavien Dindo 3a and below)(NC). The primary outcomes measured included FEV1, FVC, VE/VCO2, VO2 Peak, anaerobic threshold, Estimated Met Score (EMS). Secondary outcomes measured preexisting pulmonary complications, smoking status and operating (chest time, one lung ventilation time (OLVT)).

Results

Groups were similar in age, gender, BMI, ASA, and clinical stage. SC had a significantly less number of smokers (p=0.004) and less individuals with pulmonary disease (p=0.019). AT was higher in NC (14.15 vs 13.50, p=0.355) and VE/VCO2 was significantly greater in SC (28 vs 32, p=0.018). SC had a significantly lower FEV1 and FVC (2.12 vs 2.81, p=0.009 and 3.11 vs 3.80, p=0.010) and a trend towards a lower EMS (6.95 vs 7.25, p=0.245). There was no significant difference in chest time between NC and SC (295min vs 265min, p=0.151) and OLVT (270min vs 245min, p=0.381) in both groups.

Conclusion

VE/VCO2 ratio in thoracoscopic oesophagectomy patients is a significant predictor of postoperative complications and has increasing links to adverse outcomes. Smoking status and pulmonary history do not significantly correlate with pulmonary complications in our cohort. Lower EMS, FEV1, and FVC are significantly associated with complications. Although preoperative inspiratory muscle training has not broadly impacted postoperative outcomes, it may benefit specific groups. These variables are crucial for clinicians to consider when counselling patients and planning prehabilitation.