bluuebunny/crossref_metadata_2025 huggingface dataset:
O122 The use of directly injectable cancer therapies: a systematic review
Authors: Kler A , Fok M , Vimalachandran D
Published: May 2023

Introduction

DIT allows for targeted delivery to a cancer. This could deescalate treatments through reduced use of systemic chemotherapy, radiotherapy dosage, and avoidance of major surgery. Palliative cancers can benefit through similar means to maintain quality of life and avoid permanent interventions (such as stomas). There is no mainstream use of DIT. Therefore, the aim of this review was to assess the role of DIT in all cancers.

Methods

A systematic search was performed in the Pubmed, Web of Science, Embase and Google databases. Two authors independently searched the literature and extracted data onto a dedicated proforma. Human and animal studies were included.

Results

8,380 papers were identified, 49 studies were included; comprising of 1,087 patients for lung, H+N, brain, oesophagogastric and colorectal cancer. Four studies performed neoadjuvant DIT, where one showed all lung tumours down staged to an operative state. The remainder showed no advantage in survival or response. Palliative intra-tumoural cisplatin (in three studies) showed promise for malignant airway obstruction, where good responses were shown in > 50% of patients (single report). Cisplatin was also favourable in palliative H+N cancers (ORR=66% in one report). A minority of studies (4/49) exhibited grade 3 toxicity or higher.

Conclusion

DIT is safe to administer and demonstrated promise in the palliation of malignant airway obstruction and advanced/recurrent H+N cancer. Further studies are required to verify these results. Additionally, more reports are required to determine its role in neoadjuvant treatment.

DIT:Direct injection of chemotherapy

ORR:objective response rate

H+N:head and neck
O126 Repeat hepatic resection for recurrent colorectal metastasis
Authors: Khawaja A H , Khasati L , Hanks M , Zaitoun A M , Cameron I , Gomez D
Published: May 2023

Introduction

Liver resection offers the best curative treatment for hepatic metastases secondary to colorectal (CR) cancer. The aim of this study was to compare survival outcomes between patients having liver resection once (OR) versus those having redo-liver (RR) resection for hepatic metastases.

Methods

This was a retrospective study done on 171 patients who underwent hepatic resection (97 had OR & 74 had RR) from January 2009 to January 2020 across East Midlands hospitals.

Results

Mean age of patients in OR group was 75 years & RR group was 74. Male: female ratio was 2:1 for OR and 1.34:1 for RR group. Mean period between first and second liver resection was around 15.4 months. Minimum follow up period after surgery was 3 years. Up to the point of study till Jan.2023, overall there were 58 deaths reported out of a total of 97 patients in OR group, while in the RR group there were 39 deaths reported out of 74 patients. At 3 years follow up from initial resection, overall survival in OR patients was 58% while in the RR group was 65%. At 5 years follow up, overall survival in OR group was 40% while that of RR group was 45%. It was also noted that in the RR group, 67% (1/3) patients had lymph node positive disease (≥N1).

Conclusion

Beneficial outcome has been reported with regards to overall survival in patients undergoing redo hepatic resection and supports its role as the preferred choice of management for recurrent liver metastasis.
O127 Application of machine learning approaches in the diagnosis and management of colorectal cancer
Authors: Chowdary P , Kmiotek E K , Mirnezami R
Published: May 2023

Introduction

Colorectal cancer (CRC) is one of the most common cancers worldwide. In recent years, Artificial Intelligence (AI) and Machine Learning (ML) algorithms have gained traction in CRC research for their ability to efficiently analyse large volumes of variables and offer objective data driven models to optimise clinical decision making. The present review provides a contemporary summary of the current application of these approaches in CRC.

Methods

A literature search was performed on AI models and ML learning in CRC and relevant articles were scrutinized.

Results

AI aided detection systems were successful in identifying CRC, and able to outperform endoscopists in detecting adenomas (detection rate 0.29 vs. 0.20, p < 0.001). ML models based on radiomics showed promise in identifying CRC metastasis and even outperforming national guideline-based models (AUC 0.83 vs. 0.73, p<0.01) in predicting risk of T1 CRC metastasis to lymph nodes. ML models were also able to identify novel genomic targets, predict response to oncological therapy, and predict 5-year disease free survival in stage II and III CRC (AUC of 0.698). In the operative context, AI can be trained to identify surgical steps and operative actions with accuracy scores of over 80% as well as.

Conclusion

AI modelling takes advantage of increasing digital medical data keeping to allow rapid high-volume data analysis which has found application in the diagnosis, staging, treatment, and prognosis of CRC and may be useful in the development of intra-operative guidance systems to optimize surgical approaches and training.
O128 Time trends in opioid prescribing after discharge following colectomy in england: a cross-sectional study
Authors: Baamer R , Humes D J , Toh L , Knaggs R , Lobo D N
Published: May 2023

Introduction

Opioid prescribing patterns after discharge following colectomy within a population from England are not well characterised. This study aimed to report changes in opioid prescribing prevalence, formulation choices and opioid analgesics over time.

Methods

This cross-sectional analysis included people undergoing colectomy between 2010 and 2019 using primary (Clinical Practice Research Datalink) and linked secondary care (Hospital Episode Statistics) data. The prevalence of initial opioid prescription within 90 days of surgical discharge was calculated, and prescription characteristics in terms of analgesics and formulation were described. Trend analysis was performed using the Cochran Armitage test, and percentage change between 2010 and 2019 was tested using univariate logistic regression.

Results

Of the 95,155 individuals undergoing colectomy within the study period, 15,503 (16.3%) received opioid prescriptions. There was a decreasing trend in the prevalence of post-discharge opioids for opioid naïve people (P<0.001), with a decrease from 11.4% in 2010 to 6.7% in 2019 (-41.3%, p<0.001). Whereas the prevalence remained stable for patients prescribed opioids prior to surgery (p=0.637). The prescribing of immediate release formulations decreased from 86% in 2010 to 82% in 2019 (-4.65%). Codeine represented 44.5% of all prescriptions and prescribing increased by 14.5% between 2010 and 2019. Moreover, morphine and oxycodone prescriptions rose significantly by 76.6% and 131%, respectively, while tramadol prescribing dropped by 48%.

Conclusion

This study identified a changing pattern of opioid prescribing following colectomy, with prescribing prevalence decreasing for opioid naïve people. Trends suggested decreased tramadol prescribing, but a shift toward increasing codeine, oxycodone and morphine prescriptions.
O131 Martius flaps for rectovaginal fistulae – a systematic review and metanalysis
Authors: Swindon D , Izwan S , Ng J , Chan E , Abbas N , Von Papen M , Sahebally S M
Published: May 2023

Introduction

Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various other procedures, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition.

Methods

A PRISMA-compliant meta-analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta-analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible.

Results

Twelve non-randomized (11 retrospective, 1 prospective) studies, assessing 137 MF procedures were included. The mean age of the study population was 42.2 +/- 15.7 years. There were 45 primary and 92 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45- 98.46; I2= 32.1%; p=0.183) and that for recurrent RVF was 77.5% (95% CI: 62.24- 89.67; I2= 58.1%; p=0.008). The weighted mean complication rate was 29% (95% CI: 8.98- 54.68; I2= 85.4%; p<0.0001) and the overall recurrence rate was 12.0% (95% CI: 5.03- 21.93; I2= 52.3%; p=0.021). When purely radiotherapy-induced RVF were evaluated, the mean overall success rate was 94.6% (95% CI: 83.33- 99.75; I2= 0%; p=0.350).

Conclusion

MF interposition appears to be an effective treatment modality for RVF. Future randomized studies should be conducted to confirm these findings and to compare MF with other surgical techniques.
O133 Network meta-analysis of neoadjuvant therapy in rectal cancer
Authors: Fok M , Fowler H , Clifford R , Kler A , Gittens J , Toh S , Wade R , Vimalachandran D
Published: May 2023

Introduction

Locally advanced rectal cancer can be treated with neoadjuvant chemoradiotherapy prior to surgical resection. This treatment can significantly downstage rectal tumours and consequently lead to improved long term survival and reduced risk of local reoccurrence. Controversy exists regarding the optimal regime for neoadjuvant therapy. A network meta-analysis allows the integration of multiple treatments to be compared simultaneously in a single analysis. This network meta-analysis aims to assess which neoadjuvant regime gives the highest rate of pathological complete response (pCR).

Methods

An extensive literature search for randomised controlled trials of neoadjuvant therapy in rectal cancer was performed. The primary outcome was pCR at surgical resection. Direct and indirect comparisons were performed with a frequentist Network Meta-Analysis and results tested for consistency.

Results

Following critical appraisal of 3720 studies, 16 randomised control trials were included in the study. Regimes of neoadjuvant therapy included short course radiotherapy with concurrent chemotherapy or without, long course chemoradiotherapy, long course chemoradiotherapy with either induction of consolidation chemotherapy, and radiotherapy alone (45gy). Short course radiotherapy combined with chemotherapy was shown to produce significantly higher pCR in patients with rectal cancer. Short course radiotherapy without chemotherapy was shown to have the lowest rate of pCR.

Conclusion

There is strong evidence to suggest that short course chemoradiotherapy is the best regime to produce the highest pCR in patients with rectal cancer.
O139 High resolution anoscopy for anal intraepithelial neoplasia surveillance: new service delivery in Wales
Authors: Saji A P , Soliman F , Horwood J , Hargest R
Published: May 2023

Introduction

Anal intraepithelial neoplasia (AIN) is a pre-malignant precursor to anal squamous cell carcinoma (SCC). High Resolution Anoscopy (HRA) is utilised in the surveillance of these lesions allowing significant magnification and inspection of the perianal, vulval and anal squamous epithelium to obtain targeted biopsies from areas of suspicion. We present the experience of Wales's first HRA surveillance program.

Methods

A retrospective review of AIN patients enrolled into HRA screening was performed. The ease of establishing HRA, of running the service, histological outcomes, risk factors and complications were obtained.

Results

A business case for HRA equipment was authorised – capital cost £23850, warranty £19080 for 4 years, disposable proctoscope £25 per patient. Two surgeons trained in the use of the equipment with industry support. Twenty-six patients underwent HRA and biopsy (male: female 11:15). Patients included those with one or more of the following recognised risk factors including: transplant/immunocompromised (30.8%), HPV (50%), smoking currently or previous (61.5%), MSM (9.1% of males), VIN (86.7% of females). A total of 122 biopsies were taken (median 4 per patient (1-17)). Eight patients (30.8%) attended two or more sessions. There were no complications perioperatively. Ten patients (38.5%) found to have AIN3. Three females (20%) had VIN3. Three patients (11.5%) found to have SCC and referred to local oncology services.

Conclusion

HRA is a safe and effective surveillance programme for patients with AIN. Magnification enhances the ability to target biopsies to areas of suspicion at an early stage. Recording of images is useful in planning subsequent assessments.
O142 The application of robotic surgical approaches in the management of midgut neuroendocrine tumours: a systematic review
Authors: Jatin N , Aryan A , Zainab S , Reza M
Published: May 2023

Introduction

Robotic-assisted surgery (RAS) promises good outcomes in midgut adenocarcinoma surgery. However, its effectiveness in midgut neuroendocrine tumours (MNETs) is unknown. This study aimed to assess the current use, user interface and any emerging developments of RAS in MNET treatment using the literature available.

Methods

This review was carried out using PRISMA guidelines. MEDLINE, EMBASE and Web of Science were searched on 22nd October 2022. All studies reporting primary data on robotic surgery in midgut neuroendocrine tumours or carcinoid tumours were included. The midgut was defined to be from the duodenojejunal flexure to the splenic flexure.

Methodological quality was assessed using the Joanna Briggs critical appraisal tool.

Results

According to our systematic review protocol, nineteen studies were selected. A total of twenty-six patients were identified. RAS was used for right colectomy, right hemicolectomy, ileal resection, caecal resection, intracorporeal anastomosis and complete mesocolic excision. It offered an optimal user interface with enhanced visuals, fine dexterity, and ergonomic work position. Innovative developments in tumour-healthy tissue boundary and vasculature visualisation were reported.

Conclusion

Although the evidence base is limited, RAS for MNETs is safe and feasible. We recommend more extensive prospective-randomised controlled trials comparing it with laparoscopy and open surgery. Developments in contrast dyes and tumour-specific probes are very promising.
O143 Management strategies and outcomes for small bowel neuroendocrine tumours with involvement of the superior mesenteric vascular root: a systematic review
Authors: Kmiotek E K , Lakda S , Mirnezami R
Published: May 2023

Introduction

Small intestine neuroendocrine tumours (SI-NETs) are the most common small bowel tumours. A particularly challenging subset of these tumours are those that involve the superior mesenteric artery (SMA) or vein (SMV) for which the role and feasibility of surgery is often questioned. This review aimed to identify and evaluate the management strategies used for these complex SI-NETs.

Methods

Primary studies concerning SI-NETs with SMA and/or SMV involvement were identified from PubMed and Embase review and data abstraction was performed.

Results

Initial literature search identified 155 potentially eligible studies, from which nine non-randomised primary retrospective studies met inclusion criteria. Treatments identified include stenting the SMV, debulking and resection, auto-transplantation, and endovascular occlusion and tumour excision (EVOTE) procedures. The level of involvement of the SMA and SMV was associated with resectability such that more proximal involvement yielded a lower likelihood of successful resection. Auto-transplantation strategies may show promise in more proximal mesenteric root involvement. To date, one study reported a case of a patient with SMV encasement who was successfully treated with auto-transplantation of ileocolic and ileojejunal segments after resection of the affected structures.

Conclusion

The present study highlights a role for aggressive surgical and multimodal management in cases of SI-NETs with vascular involvement of the mesenteric root. The use of classification systems to stratify mesenteric masses by level of vascular involvement can help identify patients who could benefit from resection. Large scale prospective studies are needed to better elucidate the effectiveness of surgical management strategies in these challenging SI-NETs.
O144 The role of cytology in the investigation and management of cystic lesions of the pancreas with special reference to mucinous cystic neoplasms
Authors: Bancu A , Hanks M , Zaitoun A M
Published: May 2023

Introduction

Pancreatic cystic lesions encompass benign and malignant disease within the pancreas. Cytology has been increasingly used in the physician's toolbox to provide an accurate, non-invasive and cost-effective modality for the diagnosis of pancreatic lesions. The cytological appearance alone may be insufficient to establish the diagnosis and it's crucial for effective clinicopathological correlation in a multidisciplinary setting, highlighting the vital role of the pathologist to ensure effective and quality care.

Methods

We identified 178 cases of cystic lesions of the pancreas between 2017 and 2021. We used the C grading system and the Papanicolaou grading systems (Pap) to assess the potential risk of malignancy.

Results

We identified 20 cases with moderate and high grade intraductal papillary mucinous neoplasms (IPMN) and 12 cases of mucinous cystic neoplasms (MCN) by using the Pap grading system, 18% that may require surgical intervention. 39 cases (22%) are low grade IPMN. 72 cases are classified as high risk and potentially malignant (Pap grade 4b) in comparison with 25 cases, using the C grading (C4 and C5). The remaining cases 77 (43%) are benign to very low risk malignant potential that don't require surgical intervention.

Conclusion

The use of Pap grading allowed for a less invasive approach to tissue sampling which, when combined with routine staining and specialised immunohistochemistry can help establish the diagnosis and parameters associated with progressive malignancy. The study provides a powerful non-invasive diagnostic tool that helps in surgical decision making for patients with cystic lesions of the pancreas.
O147 The incidence and impact of pattern of metastases on treatment strategy and outcomes for patients with pancreatic cancer
Authors: Buddle E , Jaffer R , Adiamah A , Wong T , Murugan V , Wong Z , Lobo D N
Published: May 2023

Background

Pancreatic cancer is a major cause of cancer mortality with dismal survival outcomes. At the time of diagnosis, 15% of patients with pancreatic cancer have resectable disease, 35% present with locally advanced pancreatic cancer and 50% of patients present with metastatic disease. This study aimed to determine the pattern of metastatic disease in patients with pancreatic cancer and evaluate their influence on survival outcomes.

Methods

Electronic healthcare records were retrospectively reviewed at a regional hepatopancreaticobiliary centre to identify patients diagnosed with pancreatic cancer between 2010-2019 inclusive. Patient demographics, tumour characteristics, metastatic pattern and management were recorded and compared. Kaplan Meier survival analysis were used to assess survival outcomes stratified by sex, metastatic pattern, and treatment strategy.

Results

Of the 1293 patients who met the inclusion criteria, metastatic disease was present in 863 (69.1%) at diagnosis. The commonest site of metastases was liver only [25.6% (221/863], followed by disseminated metastases [24.1% (208/863)] and regional lymph nodes [22.9% (198/863)]. Only 3.7% (32/863) of patients with metastases had lung-only metastases. Detection of lung metastases synchronous with intra-abdominal metastases did not alter management. The surgical resection rate was only 15% and the 5-year survival for those who underwent surgery was 9.8% compared with 0.8% for those with unresectable disease (p<0.0001).

Conclusion

A large proportion of patients with pancreatic cancer were diagnosed with metastatic disease with the liver being the commonest site. Metastases reduce resectability rates and consequently lead to poor 5-year survival outcomes.
O148 Risk of osteoporotic fractures in patients with chronic pancreatitis: a systematic review and meta-analysis
Authors: Koh A , Oyende O , Humes D J , Lobo D N
Published: May 2023

Introduction

Chronic pancreatitis is a progressive fibroinflammatory disease and can lead to irreversible loss of pancreatic function and malnutrition. These, alongside excess alcohol intake, increase the risk of low bone density. Osteoporosis can be debilitating, reduces quality of life, increases fracture risk, and poses significant costs to healthcare. There remains, however, a paucity in current literature evaluating the prevalence of osteoporosis in this population. This meta-analysis evaluates the prevalence of osteoporosis and fractures in chronic pancreatitis.

Methods

A systematic search of Medline, Embase, CENTRAL, and ClinicalTrials.gov databases was undertaken to identify studies between January 2000 and May 2022. The primary outcome of osteoporosis prevalence and secondary outcomes of osteopenia prevalence and fragility fractures were extracted from the included studies. Where available, a subgroup analysis was performed to compare the likelihood of developing osteoporosis in chronic pancreatitis compared with control.

Results

Nineteen studies evaluating 2,027,767 participants were included in the analysis (20,463 and 2,007,304 were in the chronic pancreatitis and control groups respectively). The pooled prevalence of osteoporosis was 19% (95% CI 13-26%; I2=94%). Patients with chronic pancreatitis were more likely to have osteoporosis when compared with controls (OR 2.80, 95% CI 1.86-4.21). The prevalence of osteopenia and overall fractures were 37% (95% CI 31-44%; I2=81%) and 14% (95% CI 7-22%; I2= 99%) respectively.

Conclusion

The prevalence of osteoporosis and osteopenia are considerable in chronic pancreatitis and can also result in fractures. Further population-based studies are required to evaluate the disease burden of osteoporotic fractures and associated mortality in chronic pancreatitis.
O149 The utility of chest computed tomography in the staging of pancreatic cancer: a retrospective observational study
Authors: Jaffer R , Buddle E , Wong T , Adiamah A , Murugan V , Wong Z , Lobo D N
Published: May 2023

Background

Almost 50% of patients with pancreatic cancer initially present with metastatic disease. Current NICE guidelines recommend chest, abdomen and pelvis computed tomography (CT) for all patients with a diagnosis of pancreatic cancer. This study aimed to determine the incidence of lung metastases and the clinical utility of completion chest CT in this group.

Methods

Electronic healthcare records were retrospective reviewed at a regional hepatopancreaticobiliary centre to identify patients diagnosed with pancreatic cancer between 2010-2019 inclusive. Patient demographics, tumour characteristics, metastatic pattern and management outcomes such as surgery and chemotherapy were assessed for all patients. Kaplan Meier survival analysis were used to assess survival outcomes stratified by pattern of metastatic disease and treatment strategy.

Results

Of the 1293 patients who met the inclusion criteria 69.1%(n=863) had metastatic disease at diagnosis. Only 2.6% (32/1293) of the entire cohort presented with lung-only metastasis, with the liver being the commonest site of metastases (17.7%, 221/1293). Detection of lung metastases in the absence of intra-abdominal metastatic disease precluded surgery. However, lung metastases synchronous with intra-abdominal metastases did not alter management – chemotherapy or best supportive care. Patients with isolated lung metastasis had marginally improved median (IQR) survival [134 (48-347 days] compared with isolated liver [88 (36-221) days] and synchronous lung and liver metastases [88 (29-185) days, p<0.0001].

Conclusion

For potential surgical candidates, a chest CT would be recommended as detection of lung metastasis would alter management. However, for patients with unresectable disease, a chest CT confers no additional benefit as management strategy would remain unchanged.
O152 Zinc and copper deficiency in bariatric patients: time to revise guidelines?
Authors: Kainth R , Burton K , Sufi P
Published: May 2023

Introduction

The number of bariatric surgeries performed is increasing due to the rising incidence of obesity. It is known that mineral deficiencies can occur in the postoperative period for these procedures. We examined the prevalence of zinc and copper deficiencies before and after various bariatric procedures, with the aim of assessing the relevance of current recommendations, specifically the American Society for Metabolic & Bariatric Surgery (ASMBS) and the British Obesity and Metabolic Surgery Society (BOMSS) guidelines, regarding monitoring and supplementation.

Methods

We retrospectively analysed data of 327 patients who underwent one of three bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and mini-gastric bypass (MGB) between January 2018 and December 2019. Copper and zinc serum levels prior to surgery, and at 3, 6, and 12 months post-operation were collected.

Results

Preoperatively, 56.7% of patients undergoing bariatric surgery were zinc deficient and 32.4% had hypercupraemia. Twelve months post-surgery, 42.9% of RYGB, 35.3% of SG, and 57.7% of MGB patients with preoperative zinc deficiency presented again with a zinc deficiency requiring supplementation. Only 1 patient displayed copper deficiency preoperatively, and 6 postoperatively.

Conclusion

Screening for zinc and copper deficiencies at 6 and 12 months postoperatively, rather than at 3 months, is a more clinical and cost-effective strategy.
O153 The use of non-invasive brain stimulation techniques to reduce body weight and food cravings: a systematic review and meta-analysis
Authors: Alhindi Y , Khalifa N , Jones K , Alkhyatt W , Idris I
Published: May 2023

Introduction

Non-invasive brain stimulation (NIBS) techniques such as transcranial Direct Current Stimulation (tDCS) and transcranial Magnetic Stimulation (TMS) are safe and simple techniques that have been used to reduce body weight, food cravings and food consumption in patients with obesity. Such strategy, if effective can be used as an adjunct, prior to bariatric surgery. We therefore aim to systematically evaluate current evidence on the efficacy of active NIBS versus sham stimulation in reducing body weight and food cravings.

Methods

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) between January 1990 and February 2022. Mean differences (MDs) for continuous outcome variables with 95% confidence intervals (95% CIs) were used to examine the effects of NIBS on body weight and BMI, while the hedges's g test was used to measure the effects on food craving.

Results

Nineteen RCTs involving 571 participants were included in this study. Active neurostimulation (TMS and tDCS) was significantly more likely than sham stimulation to reduce body weight (TMS: -3.29 kg, P<0.001; tDCS: -0.82 kg, P=0.00) and BMI (TMS: - 0.74, P = 0.00; tDCS: MD= - 0.55, P = 0.54) as well as food cravings (TMS: g= -0.91, P = 0.00; tDCS: g= -0.32, P = 0.04).

Conclusion

Compared to sham stimulation, our findings indicate that active NIBS can significantly induce a reduction of body weight and food cravings. Hence, these novel techniques may be used as primary or adjunct tools in treating patients with obesity prior to bariatric surgery.
O157 Outcomes of concurrent hiatus hernia repair with different bariatric surgery procedures: a systematic review
Authors: Mills H , Al-Hindi Y , Idris I , Al-Kyhatt W
Published: May 2023

Introduction

Hiatus hernia (HH) are prevalent among patients with obesity. HH repair is often performed concurrently during bariatric surgery (BS), but a consensus on the safety and effectiveness of concurrent HH repair (HHR) and BS remains unclear. We, therefore, undertook a systematic review of the safety and effectiveness of concurrent HHR and BS through the measurement of multiple postoperative outcomes.

Methods

A comprehensive search discovered 17 studies relating to concurrent BS and HHR. BS procedures included laparoscopic Sleeve Gastrectomy (LSG), Roux-en-Y Gastric Bypass (LRYGB), and Adjustable Gastric Banding (LAGB). Extracted from these studies were pre- and post-operatives and measurements and outcomes.

Results

For LSG, 8 of 11 studies concluded concurrent procedures to be safe and effective with no increase in mortality. Reoperation rates however were increased with HHR, while GORD rates improved compared to LSG alone. For LRYGB, in all 5 studies, concurrent procedures were concluded to be safe and effective, with no increase in mortality, length of stay, readmission and reoperation rates. Higher complication rates were observed compared to LSG with HHR. Among LAGB studies, all 4 studies were concluded to be safe and effective with no adverse outcomes on mortality, length of stay and GORD rates. Reoperation rates from pouch dilatation and gastric prolapse were also observed to decrease.

Conclusion

Concurrent HHR with BS appears to be safe and effective. Assessment of BS warrants the consideration of concurrent HHR depending on specific patient case and the surgeon's preference.
O160 The utility of pre-operative localisation scans (ultrasound and Tc99M Sestamibi) for primary hyperparathyroidism is limited in up to 40% of the patients
Authors: Charakopoulou A , Chadwick D , Christakis I
Published: May 2023

Introduction

The aim of this study was to evaluate the diagnostic accuracy of pre-operative localisation scans for primary hyperparathyroidism (PHPT).

Methods

Patients with PHPT had pre-operative localisation scans; ultrasound (US) and Tc99m Sestamibi and were operated between 12/2020 and 12/2022. Patients with persistent/recurrence PHPT post-operatively were excluded.

Results

97 patients with PHPT were included. The mean age was 60 (SD:13) years old. The male/female ratio was 1:4.4. The mean hospital stay was 1.1 days (SD:0.3). 94 and 91 patients had US and Tc99m Sestamibi scans respectively while 88 patients had both scans. There was 1 patient with an ectopic mediastinal parathyroid adenoma. On the histopathology, 72 patients had single-gland disease, 13 patients had 2 abnormal parathyroid glands, 9 patients had 4-gland hyperplasia. The diagnostic accuracy, sensitivity, specificity, Positive Predictive Value and negative predictive value of US scan was 62% (95%CI: 51-72%), 64% (95%CI: 53-74%), 20% (95%CI: 0.51-72%), 93% (95%CI: 90-96%) and 3% (95%CI: 0.5-16%), respectively. In 9 patients the US missed other/extra pathologic glands. The diagnostic accuracy, sensitivity and Positive Predictive Value of Tc99m Sestamibi scan was 63% (95%CI: 53-73%), 65% (95%CI: 54-75%) and 97% (95%CI: 97-97%) respectively. In 8 patients the Tc99m Sestamibi missed other/extra pathologic glands.

Conclusion

Parathyroid pathology in primary hyperparathyroidism is complex and the diagnostic accuracy of pre-operative localisation scans (ultrasound and Tc99m Sestamibi) is limited in up to 40%. The presence of negative pre-operative localisation scans should not be an obstacle to offering the patient a curative parathyroidectomy.
O164 Mechanistic insight into autologous fat grafting (AFG) as treatment for radiation-induced fibrosis (RIF) of the skin: a systematic review
Authors: Frommer M , Pattani N , Sanghera J , Abu-Hanna J , Awad L , Langridge B , Butler P
Published: May 2023

Introduction

RIF of the skin is a common yet devastating side effect of radiotherapy. The condition significantly worsens quality of life causing both cosmetic and functional impairment, with no effective treatment. Surgical reconstruction with AFG shows great promise due to its anti-fibrotic effects, but the underlying mechanisms remain unclear. We systematically review the literature to identify the underlying mechanisms and possible therapeutic targets.

Methods

A systematic literature search was conducted using PubMed, SCOPUS, and Cochrane databases. In-vitro and in-vivo studies were included using radiation and adipose tissue fractions or isolated cell groups. Data regarding intervention, cell types, experimental model, radiation protocol, and outcomes were collected. Study quality was systematically assessed.

Results

26 studies met inclusion criteria; 8 in-vitro co-culture models and 21 in-vivo experiments. Adipose-derived stem cells (ADSCs) or ADSC conditioned medium was most commonly used in-vitro while ADSC, stromal vascular fraction, whole fat or microfat were used in-vivo. AFG and ADSCs modulated inflammation, vascularisation, apoptosis, and extracellular matrix remodelling. This included decreased collagen levels through attenuation of the TGFβ/SMAD-axis, inhibition of fibroblast-to-myofibroblast-transition, and recruitment of inflammation-resolving M2-Macrophages. The role of modulating vascularisation remains unclear. Secretion of HGF, FGF2, VEGF, and IL6 amongst others by ADSCs was suggested for these effects.

Conclusion

A combination of extracellular matrix remodelling, immunomodulation, and re-vascularisation are central mechanistic features after AFG, however, several key phenomena remain unexplained. Investigation of these pathways may identify drug targets for treating RIF and other fibrotic diseases.
O165 Cosmetic business mechanics in London: a cross sectional analysis and audit of ASA compliance
Authors: Zargaran D , Zargaran A , Sousi S , Woollard A , Davies J , Weyrich T , Mosahebi A
Published: May 2023

Introduction

We aim to perform a cross-sectional analysis of the practitioners in London, UK to evaluate the distribution of clinics within the Greater London, prices advertised for interventions, and compliance with the Advertising Standards Authority (ASA) legislation. We also aim to identify whether there are any differences in cost of Botulinum Toxin or Dermal Filler between the boroughs.

Methods

Between December 2021 and January 2022, we performed a systematic search using the internet search engine Google. Any reference to Botulinum Toxin or anti-wrinkle injections was noted and analysed. Further analysis would look to calculate price per millilitre (ml) of Botulinum Toxin and Dermal Filler per borough and to calculate whether there were any statistical differences between the 32 different London boroughs.

Results

A total of 500 websites were visited and evaluated. A total of 233 independent clinics were identified. 206/233 clinics sampled – 88% were in direct infringement of the enforcement notice through advertising a prescription medicine. The overall average cost per ml of Dermal Filler was £330.89 and there was a statically significant variance(p<0.05). The overall average cost per ml of Botulinum Toxin was £284.45 and the variance across boroughs was p=0.058.

Conclusion

This paper demonstrates poor compliance with the ASA guidelines and identifies regional variance in price and clinic density. The advertising of prescription only medication may pose a potential risk to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
O166 A standardised technique for smartphone free-flap photography
Authors: Myers H , Lindsay T
Published: May 2023

Introduction

Free-flap loss in the post-operative period results in physical and emotional morbidity and increases the difficulty of future reconstructive efforts. A variety of flap-monitoring techniques have been described, such as glucose and lactate measurement or photography. Combined photography and instant messaging provide an avenue for rapid communication. However, with increased adoption, awareness of the importance of standardised conditions has increased. Multiple techniques have been described, yet only one involves a cheap, accessible, and practical implementation of the smartphone in free-flap monitoring. This method is available only to Android users and involves additional equipment that may not be readily procured or applied. Therefore, this study presents a more universal approach to photography.

Methods

We present a simple, highly accessible and user-friendly technique for acquiring reproducible and standardised clinical images of free-flaps during the postoperative period. Our technique involves a smartphone only, can be taught in under 5 minutes and involves only three steps to take a photograph and three steps to collaborate with the MDT.

Results

In our pilot, clinicians reported that the method was easy to learn, simple to implement, and improved the standardisation of clinical photography. The technique has been adopted as standard practice for members of the Unit, and, anecdotally, has already led to improved care of patients.

Conclusion

This study describes a simple, quick, cost-effective approach to standardising clinical photography in patients undergoing free-flap surgery. Following a successful pilot, we plan to expand the study to more units before auditing the results of our intervention.
O167 A decade of NHS never events – has formal reporting made a difference?
Authors: Petrosyan V , Tsakalidis M , Ameerally P J
Published: May 2023

Introduction

NHS England defines “Never Events” (NE) as 'patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers’. NHS Organisations were required to publish NE data from April 2012. This project aims to identify changes in NE patterns to help inform training.

Methods

Published data between April 2012 and March 2022 was collected from NHS England. Data processing and manipulation was carried out using Microsoft Excel.

Results

A total of n=4,055 NE and n=175,920,530 procedures were reported. During the 2020-2021 year there were significantly less (p=0.029) NE compared to 2019-2020, however the rate of NE per million procedures (25 vs 27) remained unchanged p=0.18. Overall, there appears to be an increasing trend in NE, p<0.001. The majority of NE related to wrong site surgery, n=1,628(40%), retained foreign objects, n=1,090(27%) and wrong implant/prosthesis, n=506(12%), p<0.001. Within wrong site surgery, the most common NE was wrong procedure, n=529(32%), followed by laterality errors, n=391(24%), p<0.001.

Conclusion

The results demonstrate that despite systemic protective barriers such as the WHO Checklist, overall rate of NE has not reduced. This is likely to be confounded by changes in reporting as well as definitions, for example from April 2021 wrong tooth extraction was not considered a NE. The importance of Human Factors must not be overlooked, and NHS Trusts should consider formal provision of such training for all those in clinical roles.
O170 Open-label prospective cohort evaluating stem cell enriched lipotransfer as the treatment for vulvar lichen sclerosus
Authors: Jasionowska S , Almadori A , Ioannidi L , Hansen E , Boyle D , Zenner N , Swale V , Reid W , Mclean A , McKenzie M , Goble M , Langridge B , Butler P
Published: May 2023

Introduction

Vulval lichen sclerosus (VLS) is a chronic skin disease characterised by pain, itching, apareunia, loss of vulval architecture and scarring, resulting in poor quality of life. Stem cell enriched lipotransfer has been proposed as a treatment for patients with VLS experiencing scarring and fibrosis.

Methods

This study was an open-label prospective cohort aiming to assess the effectiveness of stem cell enriched lipotransfer in improving signs, symptoms and quality of life of patients with VLS. Patients were recruited from the local clinic. All patients received at least one treatment. Validated outcome measures were used to prospectively assess the sexual function, quality of life, and symptoms. Vulvar Architecture Severity Scale (VASS) was used to report physician-assessed disease signs.

Results

Fifty-nine patients were included. The average age was 52.9 yrs. The mean follow-up was 11.9 months. The most common symptoms included itching and pain. The most reported signs were loss of vulvar architecture and scarring. The median number of procedures was 2. The mean volume of fat injected was 11.38 cc. Patients reported a reduction in itching and burning. Lipotransfer also resulted in better sexual function and decreased distress associated with sexuality. Anxiety due to VLS was reduced by the treatment. The VASS score varied by region but there was an improvement in all affected areas.

Conclusion

Stem cell enriched lipotransfer improved signs, symptoms and quality of life of VLS patients in this cohort. A randomised controlled trial is needed to demonstrate its efficacy, safety and the underlying molecular mechanism of action.
O171 Evaluation of remote surgical wound assessment in routine surgical practice: a mixed-methods pilot implementational study of a novel mobile digital intervention
Authors: McLean K , Sgrò A , Brown L , Buijs L , Daines L , Potter M , Bouamrane M , Harrison E
Published: May 2023

Introduction

Remote postoperative wound surveillance provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot remote digital postoperative wound surveillance and evaluate the readiness for implementation in routine practice.

Methods

A single-arm implementational study of remote postoperative wound surveillance in two tertiary care hospitals (clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery received smartphone-delivered wound assessment for 30-days postoperatively (photographs and patient-reported SSI symptoms). Technology acceptance was assessed using 5-point Likert scales from the validated Telehealth Usability Questionnaire (TUQ), and summarised using means and 95% confidence intervals (CI). A mixed-methods approach was used with synthesis according to the WHO framework for monitoring and evaluating digital health interventions.

Results

200 patients participated between July 2021 and April 2022, with 115 (57.5%) undergoing emergency procedures. The 30-day SSI rate was 16.5% (n=33/200), with 72.7% (n=24) diagnosed post-discharge. Usage of the intervention was 83.0% (n=166/200), with subsequently 74.1% (n=123/166) TUQ completion. Patient acceptance was high with regards to satisfaction (4.27, CI: 4.13-4.41) and usefulness (4.07, CI: 3.92-4.23). Communication was rated lowest (3.86, CI: 3.71-4.02), related to the desire for more frequent and personalised interactions with the surgical team. Nevertheless, the majority perceived improved quality (3.72, CI: 3.56-3.89) and efficiency (4.08, CI: 3.93-4.23) over routine postoperative care.

Conclusion

Remote postoperative wound surveillance successfully demonstrates readiness for implementation according to the WHO framework. Both patients and healthcare services can benefit from enhanced community support to ensure appropriate and timely management.
P03 Surgical trainees’ burnout during COVID-19 pandemic
Authors: Egbe A , Abuelgasim M , El Boghdady M
Published: May 2023

Introduction

The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. We aimed to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialities, and to identify factors that may modify the risk of burnout.

Methods

A systematic review was performed in compliance with the PRISMA guidelines to identify articles related to the keywords “surgeons’ burnout and Covid-19’’ and “surgical trainees’ burnout and Covid-19”. A search was performed on PubMed/Medline and ScienceDirect for articles published from January 2020 to August 2022.

Results

A total of 19 articles met the inclusion criteria, 3866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees during the pandemic was between 9.0%-95.2% across the globe. Burnout rates were higher in general surgery (33.1%-95.2%) than in urology (17.6%-55%), neurosurgery (16.2%-44.1%), and orthopaedic surgery (9% - 44.1%). Otorhinolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included female gender, being a more junior trainee, and increased working hours.

Conclusion

There has been a high level of burnout amongst surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training, and the serious consequences of surgeons’ burnout both for the individual, and for patients, targeted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed and must be prioritised by healthcare institutions and training programmes.
P08 A systematic review of the optimal assessment tools to evaluate treatment efficacy in vulval lichen sclerosus
Authors: Jasionowska S , Almadori A , Goble M , Langridge B , Iakovou D , Kamel F , McKenzie M , Butler P
Published: May 2023

Introduction

Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by pain, itching, burning, apareunia, loss of vulval architecture and scarring. Despite its detrimental effect on patients’ quality of life, the evidence on currently available treatments remains scarce. Heterogeneity in outcome reporting precludes a meaningful comparison and evaluation of different treatments. This study aimed to systematically review the available evidence for VLS treatments and methods of outcome reporting.

Methods

The review followed PRISMA guidelines using a registered protocol (PROSPERO:CRD42022356738). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial registries. All randomised controlled studies (RCTs) assessing the outcomes of patients undergoing any treatment for VLS were eligible for inclusion.

Results

A total of 775 patients were assessed across 21 RCTs. The identified assessment tools reported outcomes in the following domains: patient-reported symptoms assessed with one validated scale in 12 studies and seven non-validated scales in nine studies; sexual function with validated FSFI and FSDS in two studies and two non-validates scales in two studies; quality of life with three validated scales in three studies; clinician-reported objective outcomes with two validated scales in three studies and six non-validated scales in fourteen studies. Histological changes were assessed in 10 studies and tissue biomechanics in one.

Conclusion

There is high heterogeneity in assessing treatment outcomes for VLS. To appropriately evaluate and compare the effectiveness of any treatment as a VLS intervention, it is crucial to adopt a core set of outcome measures.