bluuebunny/crossref_metadata_2025 huggingface dataset:
HPB P08 Exploring Carbon-13 breath delta value and other biomarkers of infection following Liver Transplantation and Hepatopancreatobiliary Surgery
Authors: Jerome Ellen , Wall Thomas , Pinto Tomas , Trovato Francesca , Mujib Salma , Cavazza Anna , Napoli Salvatore , Weidmann Damien , McPhail Mark , Menon Krish
Published: December 2022

Background

Sepsis and infection are the leading cause of morbidity and mortality after surgery, but the inflammatory response to the trauma of surgery can make diagnosis challenging. Carbon-13 breath delta value (13C BDV) has been shown to be discriminant as a novel diagnostic marker for sepsis and infection. We aim to assess biomarkers including BDV following major hepatopancreatobiliary (HPB) surgery to diagnose postoperative infection/sepsis.

Methods

20 participants undergoing HPB surgery were recruited prospectively. Breath samples were collected from baseline preoperatively, and on postoperative days (POD) 1–9, with plasma and peripheral blood mononuclear cell (PBMC) samples preoperatively, POD1, 4 and 8. Breath samples were analysed using infrared laser spectroscopy to generate BDV (per mil). Plasma was analysed for cytokines using MesoScale Discovery immunoassay, Procalcitonin (PCT) using ELISA, and Cell surface marker expression on monocytes was phenotyped using flow cytometry. Differences between groups who did and did not develop infective complications was analysed using two-way ANOVA and Mann Whitney U test.

Results

5/20 participants developed infective complications, with a mean day of diagnosis POD5. There was no difference between BDV in patients with or without infection. Monocyte count was increased in infected participants at all timepoints, and monocyte expression of PD-L1 on POD1, and CD155 and HLA-DR on POD4 was upregulated, +13.09% (95%CI 1.59 to 24.61, p<0.05), +422.5 MFI (95% CI -770.9 to -73.68, p<0.05), and +19.02% (95% CI 37.58 to 0.45, p<0.05) respectively.

Conclusions

Monocyte expression of PD-L1, HLA-DR and CD155 is associated with infection, +13.09% (p<0.05), +422.5 MFI (p<0.05), and +19.02% (p<0.05) respectively. The innate immune system is dysregulated in infection following major HPB surgery. In this cohort BDV did not predict infection. Further investigation of novel biomarkers including BDV and soluble monocyte markers is required.
HPB P26 C-reactive protein/albumin ratio may be helpful for assessing suitability for resection in patients with pancreatic head malignancy
Authors: Russell Thomas , Labib Peter , Aroori Somaiah
Published: December 2022

Background

Prior studies have suggested that high preoperative C-reactive protein/albumin ratio (CAR) correlates with reduced survival following pancreatoduodenectomy (PD) performed for malignancy affecting the pancreatic head, since this feature is characteristic of a more aggressive tumour. Various cut-off thresholds have been suggested, with a threshold of 0.2 (x10–3) considered in several publications. This study aimed to compare the five-year survival of PD patients with high preoperative CAR (≥0.2) to those with low preoperative CAR (<0.2).

Methods

Data was extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective cohort study of outcomes following pancreatoduodenectomy performed for pancreatic head malignancy (29 centres in 8 countries, n=1,484). Patients were grouped by their underlying cancer type and divided into “high” and “low” CAR groups. Five-year survival rates were compared using Fisher's exact test.

Results

Out of 1484 patients, 885 (59.6%) had pancreatic ductal adenocarcinoma (PDAC), 394 (26.5%) had ampullary carcinoma (AA) and 205 (13.8%) had cholangiocarcinoma, and CAR data was available for 48.8%, 42.6% and 44.4% of patients, respectively. In patients with PDAC, the median CAR was 0.2 (range: 0.0–23.8) and low CAR was associated with significantly improved five-year survival (32.6% vs 18.0%, p=0.0006). In those with AA, median CAR was 0.2 (range 0.0–19.5), those with low CAR had improved five-year survival but this was not quite significant (60.3% vs 46.7%, p=0.09). Median CAR was 0.3 in those with CC (range: 0.0–14.3) but this did not appear to affect survival (33.9% vs 30.8%, p=0.7).

Conclusions

In our multicentre study, PD patients with a histological diagnosis of PDAC had significantly improved five-year survival rates if they had a low CAR. CAR is a useful prognostic indicator in these patients and may be helpful for assessing patient's suitability for resection.
HPB P45 Ciliated Hepatic Foregut Cysts: Not as Rare as Previously Believed
Authors: Hughes Daniel , Tsakok Maria , Patel Nikhil , Rendek Aniko , Bungay Helen , Silva Michael
Published: December 2022

Background

Ciliated hepatic foregut cysts (CHFCs) are uncommon cystic lesions within the liver. CHFCs can undergo a malignant transformation to form a primary squamous cell carcinoma of the liver. The true incidence and natural history of CHFCs is unknown and the risk of malignant transformation is unclear. We present a single centre’ s experience of CFHC management.

Methods

A retrospective review of a departmental database identified all patients with CHFCs over a 4 year time period. Patients with CHFCs confirmed on histological assessment or suspected on radiological imaging were included in this study. Clinical information regarding patient demographics, symptomatic presentation, surgical management and histopathological features were noted. The radiological characteristics of CHFCs were recorded and the malignant transformation rate was calculated

Results

15 patients with CHFC were identified (7 histologically confirmed and 8 radiologically suspected cases). All patients were asymptomatic and the CHFCs were incidental findings.No CHFC developed an interval change in cyst features or underwent a malignant transformation during follow up. MRI serves as the most sensitive modality to diagnose CHFC

Conclusions

CHFCs may be more prevalent than previously reported. Definitive management should encompass a patient centred discussion regarding the merits of long term follow up with serial imaging versus resection on an individual basis once CHFC is diagnosed.
HPB P47 Management of acalculous cholecystitis: Experiences from a district general hospital
Authors: Suresan Srutti , Shaukat Mubasher , Ahmad Reddin , BinSahl Abdullah , Naeem Hamza , Peter Mark
Published: December 2022

Background

Acalculous cholecystitis (AC) is a serious inflammatory condition of the gallbladder with associated high morbidity and mortality. Definitive management of AC involves cholecystectomy and/or cholecystostomy in combination with antibiotic therapy. Due to the lack of consensus regarding the optimal management of AC leading to possible variability in clinical practice, this study aims to review the management of AC in this busy district general hospital.

Methods

Data were collected retrospectively on consecutive patients with diagnosis of cholecystitis from March 2018 to March 2020. The data was analysed and patients with confirmed gallstones on imaging and no clinical/radiological signs of cholecystitis were excluded. In this two-year study period, a total of 61 patients were treated for AC.

Results

Twenty-eight patients were managed conservatively with antibiotics (median age of 68 and median ASA of 2). Thirty-three patients were offered definitive management; cholecystostomy (2 inpatients), laparoscopic cholecystectomy (9 inpatients and 13 elective patients), 5 remain on the waiting list for surgery and 4 declined surgery. Among patients who were offered definitive management, the median age was 62 and median ASA was 2. Seven patients developed complications of AC; 2 patients underwent acute laparoscopic cholecystectomy, 2 patients were offered elective laparoscopic cholecystectomy after having a cholecystostomy, 1 patient underwent cholecystostomy, 1 patient was offered elective laparoscopic cholecystectomy after antibiotic treatment and 1 patient was treated with antibiotics alone. 30-day readmission rate was similar between patients with conservative management (5 patients) and definitive management (4 patients).

Conclusions

With similar re-admission rates, this small study suggests that definitive management options may not be superior to antimicrobial therapy alone and demonstrates that management can be tailored according to clinical needs. A larger prospective study is recommended to fully assess the efficacy and safety of laparoscopic cholecystectomy, cholecystostomy and antibiotic therapy in managing AC.
HPB P53 Outcomes after remnant cholecystectomy: is laparoscopic approach feasible?
Authors: Ibrahim Rashid , Abdalkoddus Muhammad , Mownah Omar A , chanthu Aye , Yao Lu , Aroori Somaiah
Published: December 2022

Background

Subtotal cholecystectomy (STC) is perceived as a safe approach in difficult cholecystectomies to prevent bile duct and vascular injury. However, the gallbladder remnant can become symptomatic, necessitating further surgical intervention. This study aims to evaluate the safety profile and peri-operative outcomes of remnant cholecystectomy (RC)

Methods

We retrospectively reviewed the records of all patients that underwent STC from 2009 to 2019. Patients that underwent RC were included in the study.

Results

We identified 97 STC patients during the study period. Of this cohort, 16 patients (16.5%) presented with symptoms attributed to remnant gallbladder. The median age of this group was 64 years [Inter quartile range (IQR) 54–69] with equal male to female distribution. The median body mass index: 31kg/m2 (IQR 28–33). Twelve patients then proceeded to RC. All cases were performed by a consultant Hepatobiliary surgeon in an elective setting. The median operative time was 88 minutes (IQR 80–96) with 67% completed laparoscopically. No patients suffered bile duct injury. Median hospital was 3 days (IQR 1–5). Readmission rate was zero. One patient suffered with post-op hypotension requiring inotropic support. Overall mortality is zero. At the end of the follow up period [median of 14 months (IQR 2–26)], 8 patients (67%) reported symptoms resolution.

Conclusions

Remnant cholecystectomy is a safe operation that can be performed laparoscopically. It has a low complications rate and relatively short hospital stay when performed by an experienced surgeon. However, symptomatic resolution is not achievable in all cases.
HPB P54 General surgery telemedicine clinics: here to stay post-pandemic?
Authors: Urbonas Tomas , King Emily , Pepes Sophia , Ceresa Carlo , Gordon-Weeks Alex , Reddy Srikanth
Published: December 2022

Background

The telemedicine clinic in general surgery has become widespread since the onset of the COVID-19 pandemic and has remained so following relaxation of restrictions on conventional face-to-face appointments. However, there has been significant scepticism regarding its continued utility. In particular, there is a concern that patients cannot be adequately assessed and counselled for invasive procedures, which may result in high cancellation rates on the day of procedure. The aim of this study was to assess the cancellation rate on the day of surgery for procedures booked in telemedicine clinics.

Methods

We conducted a retrospective analysis of surgical procedures booked via hepatopancreatobiliary (HPB) and general surgery telemedicine clinics from March 2020 to November 2021. From September 2020 onwards, telemedicine clinics were only run for laparoscopic cholecystectomies for benign gallbladder disease. The primary outcome was the cancellation rate of surgical cases booked from telemedicine clinics. Statistical analysis was done using JASP 0.16.2 software.

Results

We identified 240 cases booked for surgery from telemedicine clinic. 162 patients (68%) were female; the median age of the study population was 51 (16–81). 186 (78%) patients had gallstones, 19 (8%) gallbladder polyps, 13 (5%) secondary liver tumour, 5 (2%) liver cyst, 5 (2%) pancreatic tumour, 4 (1.7%) primary liver tumour, 2 (0.8%) gallbladder tumour and 6 (2.5%) other pathologies. 225 patients (94%) underwent surgery on their first admission. Procedures included 192 cholecystectomies, 10 open segmental liver resections, 6 laparoscopic segmental liver resections, 4 distal pancreatectomies, 3 open right hepatectomies, 2 Whipple procedures, 2 laparoscopic deroofing of the liver cyst, 2 laparoscopic lymph node biopsy, 1 extended right hepatectomy, 1 left hepatectomy, 1 small bowel resection and 1 exploratory laparotomy. 15 (6%) patients had surgery cancelled on the day of surgery, 14 of those were for laparoscopic cholecystectomy, 1 for laparoscopic liver resection. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. The majority 212 (88%) of patients were ASA class 1–2; only 28 (12%) were ASA class 3. There was no significant association between high ASA (3) and cancellation rate (Chi square test 5% vs 14% p=0.062).

Conclusions

Telemedicine clinic in general surgery was often the only option to assess and plan operative management for newly referred patients during the COVID-19 pandemic. Our series showed that it was feasible to assess and counsel patients on the phone even for major HPB procedures with a minimal cancellation rate on the day of operation.
OGC P04 Spatial sampling of Barrett's oesophagus reveals that tumour heterogeneity is not a useful predictor of progression to cancer
Authors: Katz-Summercorn Annalise , Peneva Iliana , Frangou Anna , Jammula Sriganesh , O'Donovan Maria , Tripathi Monika , Malhotra Shalini , di Pietro Massimiliano , Devonshire Ginny , Redmond Aisling , Wedge David , Fitzgerald Rebecca
Published: December 2022

Background

Intra-tumour heterogeneity has been well-described in oesophageal adenocarcinoma and Barrett's oesophagus (BE) segments also consist of multiple clones (groups of cells which share mutations). In BE there is some suggestion that the number of individual genetic clones within the segment and the diversity of the segment can be predictors of progression to cancer. However, this was with pre- whole genome sequencing (WGS) methods. In this study we consider the detailed spatial maps of ten patients with different disease trajectories, using WGS, to determine the heterogeneity and correlate it with their progression.

Methods

We performed WGS (50x) on 35 high-quality, frozen, endoscopic biopsies taken spatially from ten cases (8 males, 2 females, median age 75 (range 31–83). This included 4 long-term non-dysplastic (ND) patients with long BE segments and 6 patients with dysplasia. We used the copy number and purity information (from Battenberg) and the somatic mutation clustering information (from DPClust) to infer the clonal and subclonal architecture of individual biopsies and looked at the spatial relationship between biopsies within the segment.

Results

In both ND and dysplastic BE we saw cells with unrelated patterns of mutations, or clones, implying completely separate origins for different parts of the segments. This suggests independent or parallel evolution. There was a higher burden of shared (truncal) mutations in the dysplastic biopsies (p=0.049), indicating a more recent clonal sweep with some clones being outcompeted. Dysplastic samples had more subclonal copy number aberrations and more clonal driver mutations. In addition, most of the driver gene alterations in the dysplastic trees occurred early, whereas CDKN2A, the p16 locus, was the only truncal mutation found on the ND clone trees. We did not find the number of clones or the diversity of the segment to differ between the two groups.

Conclusions

Each individual patient showed complex, distinct genomic features and evolutionary trajectories. Some cases arose from a single ancestral clone, while others had few shared mutational variants suggesting multiple clones. Importantly, in this sample of cases we did not see any trend that the clonal diversity or number of clones correlated with progression to cancer. This is different to previous studies and highlights the importance of multiple sampling to determine the propensity for cancer progression even if the samples look similar histologically.
OGC P06 Has the affluent oesophageal cancer population in Scotland fared worseduring the Covid-19 pandemic?
Authors: Khan Khurram , Baxter Mark , Gall Lewis , Samuelson Catherine , Narramneni Lakshmi , Al-Zuabi Manaf , Bryce Gavin , Shareef Hala , Petty Russell , Forshaw Matthew
Published: December 2022

Background

COVID-19 has significantly disrupted cancer care. This has impacted on staging, management and survival of oesophageal cancer as health services worldwide had to adapt. Responding to the pandemic, the UK government declared a national lockdown on 23rd March 2020. Our aim was to determine the impact of COVID-19 and socio-economic deprivation on patients with oesophageal cancers.

Methods

This was a retrospective cohort study. Consecutive new patients presenting in NHS Scotland to five regional OG cancer MDTs covering 93.2% of the Scottish population between October 2019 and September 2020 were identified. Electronic health records were reviewed. Patient's residential address was used to calculate Scottish Index of Multiple Deprivation (SIMD). Patients were divided into two groups: most deprived (SIMD 1–5) and least deprived (SIMD 6–10) and results compared. The study period was divided into pre- and post-lockdown, based on the first UK national lockdown on 23rd March 2020.

Results

728 patients with were identified, 5 were excluded due to unrecognised postcode. 365 (50.5%) were in the more deprived and 358 (49.5%) were in least deprived group. 488 (67.0%) were male and the median age was 71 years (range 25-95).

Deprivation and lockdown: Age, sex, WHO performance status and route of referral was not significantly different. No clinically meaningful difference in median time to gastroscopy was observed. Palliative intent treatment increased in the most deprived from 67.0% to 71.4% and in least deprived from 54.0% to 74.0% (p=0.002).

The overall survival for the whole cohort decreased post-lockdown (11.3 vs 7.8 months, p=0.001). Pre-lockdown the median survival for most deprived group was 8.9 vs 15 months for the least deprived group (p=0.001). Post-lockdown the median survival was similar irrespective of socioeconomic status (7.8 vs 6.9 months, p=0.99). The medial survival did not changed post-lockdown for the most deprived group (8.9 vs 7.8 months, p=0.480). However, the median survival for the least deprived group significantly decreased post lockdown (15 vs 6.9 months, p<0.001).

A test of heterogeneity between lockdown period and SIMD group supported the suggestion that least deprived group did worse post-lockdown (HR 1.45, p=0.035).

Conclusions

This national study highlights that the least deprived patients had survival advantage pre-lockdown, which has been completely lost due to the lockdown. This disproportionate impact on the least deprived patients could be because early cancers were not diagnosed in the least deprived population.
OGC P07 A Preoperative Predictive Tool to Assess the Need for Staging Laparoscopy in Oesophagogastric Cancer Patients
Authors: Halle-Smith James , Bage Timothy , Kamarajah Sivesh , Pande Rupaly , Whiting John , Griffiths Ewen
Published: December 2022

Background

Staging laparoscopy (SL) has become commonplace in the preoperative staging pathway for oesophagogastric (OG) cancer due to the tendency for peritoneal carcinomatosis (PC) to be present, which may be macroscopic peritoneal metastases (PM) or positive peritoneal cytology (PPC). The aim of this study was to develop an objective risk scoring system to predict both PM and PPC at SL.

Methods

A prospectively collected and maintained database of all OG cancer patients treated between 2006-2020 was reviewed. Univariate and multivariate analyses were performed to identify risk factors for both PM and PPC at SL. A risk score was then produced for both PM and PPC, then internally validated.

Results

Amongst 968 patients who underwent SL, 96 (9.9%) patients had PM and 81 (8.4%) had PPC at SL. Tumour site (p<0.001), CT T stage (p<0.001) and N stage (p=0.029) were significantly associated with PM at SL. (p<0.001). Tumour site (p<0.001), biopsy histology (p=0.041) CT T stage (p<0.001) and N stage (p<0.001) were significantly associated with PPC. The risk scoring model for PM included cancer site and CT T stage. This was successfully tested on the validation set (AUROC = 0.730). The risk scoring model for PPC included cancer site, CT T and N stage. This was successfully tested on the validation set (AUROC = 0.773).

Conclusions

The present risk scores are valid tools with which to predict the risk PM and PPC in patients undergoing SL for OG cancer and may help to avoid subjecting patients to unnecessary SL.
OGC P08 A machine-learning approach to predict Upper Gastrointestinal multidisciplinary team treatment decisions
Authors: Thavanesan Navamayooran , Vigneswaran Ganesh , Rahman Saqib , Underwood Timothy
Published: December 2022

Background

The complexity of the Upper Gastrointestinal (UGI) multidisciplinary team (MDT) is growing, leading to rising clinician workload, time pressures and demands. This increases heterogeneity or ‘noise’ within decision-making for patients with oesophageal cancer (OC) and may lead to inconsistent treatment decisions. In this context, machine learning (ML) approaches offer the potential to standardize, automate and produce more consistent, data-driven decisions. Such models benefit from incorporating information-rich, diverse datasets to increase predictive model accuracy.

The aim of this study was to develop a model capable of predicting UGI MDT treatment decisions for OC patients (whether the patient should receive surgery alone (S), chemotherapy prior to surgery (C+S) or chemoradiotherapy prior to surgery (CRT+S)) using only variables available at the time of the first treatment decision.

Methods

We conducted a retrospective analysis of patients who underwent oesophageal cancer resections between 2010–2016. Twenty pre-operative clinical variables available to the MDT were used to develop a predictive machine learning model using a penalised Multinomial Logistic Regression (MLR) classifier with 10-fold cross-validation and 5 repeats.

Results

A total of 399 cases were identified with a male: female ratio of 3.6:1, and median age of 66.1yrs (range 32–83 yrs). The overall model accuracy was 61.4% (Kappa 0.399). A Receiver Operator Characteristic analysis produced an Area Under Curve of 87.7% for Surgery vs. CRT+S, 86.9% for Surgery vs C+S and 66.1% for C+S vs CRT+S when trialled on a validation set.

Conclusions

These results suggest even basic ML modelling techniques offer the potential to model and predict current UGI MDT treatment decisions when selecting patients for surgery or neoadjuvant therapy options. Such models may allow prioritization of caseload, improve efficiency, potentially reduce waiting times, and offer data-driven decisions where more complex cases pose challenges. While this study is the first step in such a process, future work will need to incorporate additional data modalities such as medical imaging and histopathology as well as expansion to other ML classifier algorithms to determine the best performing models in order to improve overall predictive accuracy.
OGC P13 Outcomes of Endoscopically Guided Stent Insertion in the Upper GI Tract in a Single Centre
Authors: Hossain Tanvir , Le Giang , Purbe Ripak , Kee Ling , Bushra Anika , Jackson Andrew , Trotter Martin , Parsons Simon L
Published: December 2022

Background

Self-expanding metal stents (SEMS) are useful for palliation in patients suffering from dysphagia for malignant disease in the upper gi tract. Patients can resume oral intake, so improving nutrition and quality of life. Establishing the efficacy and complication rate of stents are important for informing patients to aid decision making when giving consent for SEMS insertion in the scenario of a short life expectancy.

Methods

A single centre's records were interrogated over a 10 year period for stents inserted in the upper gi tract. Data for stents inserted between 2011 and 2021 was retrospectively collected from electronic records for baseline demographics and outcomes in terms of complications and then subject to analysis. There was missing data in a number of domains and analysis was done on data available, no imputation of data was performed.

Results

Five hundred and sixty eight patient episodes were identified with a mean age of 73. There were 386 males and 170 females. Sites of obstruction were Lower Third of the oesophagus 279, mid-oesophagus 71, GOJ 37, upper oesophagus 15, unknown 9, duodenum 3, Cardia 1, and stomach other 1. Surgeons inserted 394 (70%) of stents and gastroenterologists 167 (30%). There were 212 covered stents, 248 not specified, 29 partially covered and 3 uncovered.

When outcomes were measured, 276 had no complication (69%), 105 had a (any) complication (25%) and 32 had missing data (8%). There were 14 cases of bleeding (3%). There were 25 cases of stent migration (6%) and 54 cases of tumour overgrowth (13%). There were 43 cases of stent obstruction (10.4%), 3 cases of some stricturing (0.73%) and 366 with no blockage or stricture reported (88.6%), 1 case could not be determined. There were 2 cases of perforation (0.48%). Median survival was 105 days with IQR 44–210.

Conclusions

Our results for adverse events are not too dissimilar to the literature however there may be an under-reporting of some adverse events due to the terminal nature of the disease process the majority of the patients in this group have. Stents can relieve dysphagia and help regain quality of life. However there is a significant complication rate that should be taken into account. This information from a large dataset is useful to inform potential stent patients to aid decision-making. Data for significant known symptoms such as reflux and retrosternal chest pain were not reliably available and a prospectively kept database measuring PROMs information including relief of dysphagia will better inform patients.
OGC P15 Outcomes of Endoscopic Submucosal Dissection for Neoplasia in Barrett's Oesophagus at a Single Tertiary UK Centre
Authors: Siggens Katie , Htet Hein , Abdelrahim Mohamed , Aslam Shahila , Subramaniam Sharmila , Bhandari Pradeep
Published: December 2022

Background

Endoscopic therapies for dysplasia or early cancer in Barrett's Oesophagus have become well established over recent years. Endoscopic Submucosal Dissection (ESD) offers the benefit of en bloc resection and accurate histological staging of lesions which is particularly advantageous in cancers and may eliminate the need for major surgery in selected patients. However, ESD is not widely available in the United Kingdom (UK) and it remains a high risk procedure in Western settings with complication rates of up to 12–27% reported in the literature. Here we report our outcomes at a single tertiary referral centre in the UK.

Methods

Retrospective review of prospectively maintained database.

Results

244 consecutive ESD were carried out in patients with Barrett's neoplasia with visible lesions. The mean age was 69.8 years and 201 patients were male. Median Prague classification was C2M5. The median lesion size was 30mm (range 5–120mm). En bloc resection was achieved in 95.5% of cases. Bleeding, perforation and strictures occurred in 0.82%, 0.82% and 6.97% of cases respectively. These were all managed endoscopically.

Histology showed low grade dysplasia in 12 cases, high grade dysplasia in 37 cases, and adenocarcinoma in 192 cases. In the cases of adenocarcinoma, 131 were intramucosal (stage pT1a) and 60 were submucosally invasive (pT1b). Of the submucosally invasive cancers, 36 were SM1 and 24 >SM1. R0 resection was achieved in 74% of cancer cases.

Following ESD, 93 patients underwent ablation of residual Barrett's, 25 underwent further endoscopic resection, 21 entered endoscopic surveillance only and 25 patients underwent oesophagectomy.

Of the patients who underwent oesophagectomy, 9 were for T1b >SM1 disease, 8 for poor prognostic factors (including poorly differentiated adenocarcinoma, lymphovascular invasion or signet ring cells), 4 for R1 resection at deep margin, 3 for patient choice and 2 for difficult recurrence.

Conclusions

Our data demonstrates that ESD can be effectively targeted for cancers in patients based on endoscopic assessment by experienced endoscopists with 78.7% of procedures being carried out for early cancers. ESD is safe and effective in the majority of patients and informed the need for surgery in the appropriate group of individuals.
OGC P23 Omentopexy Reduces the Incidence of Symptomatic Post-Operative Diaphragmatic Herniation Following Minimally Invasive Oesophagectomy: a 15-year Prospective Study in a UK Specialist Centre
Authors: Doe Matthew , Brown Oliver , Jones Michael , Dwerryhouse Simon , Higgs Simon , Hornby Steve , Messenger David , Wadley Martin
Published: December 2022

Background

Post-oesophagectomy diaphragmatic hernia (PODH) occurs in up to 26% of laparoscopically assisted oesophagectomy. Preventative measures have been suggested, but no formal efficacy data are available. This study compared the incidence of symptomatic PODH before and after introduction of omentopexy in a UK specialist centre.

Methods

Consecutive patients undergoing oesophagectomy using a laparoscopic abdominal approach between 2005 and 2020 were included. Omentopexy was introduced in 2014 and was achieved by suture fixation of the greater omentum to the anterior abdominal wall around or lateral to the feeding jejunostomy. Patient demographics, surgical details and complications were collected from a prospective database. All patients were followed up for a minimum of 2 years.

Results

Symptomatic PODH developed in 7 of 142 patients (4.9%) in the omentopexy cohort, compared to 9 of 68 patients (13.2%) in the non-omentopexy cohort [Odds Ratio = 0.32 (95% Confidence Interval: 0.12–0.91), p=0.032]. Five of the 9 PODHs in the non-omentopexy cohort developed in the early post-operative period, whereas no early PODHs developed in the omentopexy cohort. There were no complications attributable to omentopexy.

Conclusions

Omentopexy is safe and effective at reducing the incidence of symptomatic PODH, particularly in the early post-operative period, and should be routinely performed in all patients undergoing laparoscopically assisted oesophagectomy.
OGC P34 Endoscopy vacuum therapy for anastomotic leak after oesophagectomy – A single centre's experience
Authors: (Linda) Lin Yi-Tzu , Almonib Ahmed , Tan Benjamin
Published: December 2022

Background

Anastomotic leak is one of the major complications following oesophagectomy and is associated with a prolonged ICU and hospital stay with high mortality. Over the years, endoscopic vacuum therapy (EVT) has an evolving role in managing anastomotic leak. The aim of this study was evaluate our experience in the use of EVT in managing anastomotic leak.

Methods

A retrospective analysis was conducted in patients who underwent elective oesophagectomy at our tertiary centre from May 2021 to April 2022. Patient demographics, complication profiles, length of stay (LOS) and survival outcomes were collected. The details of endoscopic procedure, therapy results, and adverse events were evaluated. Endo-SPONGE® by B Braun Medical Ltd was used at our centre.

Results

Over the last 12 months, 3 out of 11 patients (27.3%) who had anastomotic leak were treated with EVT. All 3 patients were males and diagnosed with anastomotic leak on Day 8, 9, 9. Two patients were treated with a stent at the time of the diagnosis and the management changed to Endo-Sponge on the subsequent endoscopy as the defect increased in size. They required 3 and 8 times of sponge exchange respectively. One patient was managed with Endo-Sponge at the time of diagnosis and required 7 times of sponge exchange. The successful anastomotic leak healing rate was 100% and none of them required further endoscopic or surgical interventions. The median changing time interval of sponges was 3 days (range 2–5 days). The average sponge exchange rate was 6 times. The median duration of EVT was 25 days (range 18–29 days). No other adverse events occurred during EVT. The average LOS was 49.3 days.

Conclusions

EVT is an effective and safe treatment option in patients with anastomotic leak post oesophagectomy for oesophageal cancer. With careful patient selection, EVT can be considered as the first-line treatment instead of surgery. Future studies involving a greater number of patients are essential to evaluate the efficacy of EVT.
Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by radical surgery for locally advanced oesophageal squamous cell carcinoma: meta-analysis
Authors: Kamarajah Sivesh K , Evans Richard P T , Griffiths Ewen A , Gossage James A , Pucher Philip H
Published: December 2022

Background

The literature lacks robust evidence comparing definitive chemoradiotherapy (dCRT) with neoadjuvant chemoradiotherapy and surgery (nCRS) for oesophageal squamous cell carcinoma (ESCC). This study aimed to compare long-term survival of these approaches in patients with ESCC.

Methods

A systematic review performed according to PRISMA guidelines included studies identified from PubMed, Scopus, and Cochrane CENTRAL databases up to July 2021 comparing outcomes between dCRT and nCRS for ESCC. The main outcome measure was overall survival (OS), secondary outcome was disease-free survival (DFS). A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs).

Results

Ten studies including 14 092 patients were included, of which 30 per cent received nCRS. Three studies were randomized clinical trials (RCTs) and the remainder were retrospective cohort studies. dCRT and nCRS regimens were reported in six studies and surgical quality control was reported in two studies. Outcomes for OS and DFS were reported in eight and three studies respectively. Following meta-analysis, nCRS demonstrated significantly longer OS (HR 0.68, 95 per cent c.i. 0.54 to 0.87, P < 0.001) and DFS (HR 0.50, 95 per cent c.i. 0.36 to 0.70, P < 0.001) compared with dCRT.

Conclusion

Neoadjuvant chemoradiotherapy followed by oesophagectomy correlated with improved survival compared with definitive chemoradiation in the treatment of ESCC; however, there is a lack of literature on RCTs.
Service users’ experiences of social and psychological avoidable harm in mental health social care in England: Findings of a scoping review
Authors: Carr Sarah , Hudson Georgie , Amson Noa , Hisham Idura N , Coldham Tina , Gould Dorothy , Hodges Kathryn , Sweeney Angela
Published: December 2022

Avoidable harm—that is, harm to service users caused by unsafe or improper interventions, practices or services and which could have been mitigated or prevented—is embedded in social care legislation and inspections. However, the concept of avoidable harm has largely been defined by policymakers, academics, practitioners, regulators and services, with little known about service users’ experiences of avoidable harm in practice. This survivor-controlled review maps and synthesises peer-reviewed literature on service users experience of social and psychological avoidable harm in mental health social care (MHSC) in England. The review was guided by an Advisory Group of practitioners and service users. Six databases were systematically searched between January 2008 and June 2020 to identify relevant literature. Following de-duplication, 3,529 records were screened using inclusion and exclusion criteria. This led to full-text screening of eighty-four records and a final corpus of twenty-two papers. Following data extraction, thematic analysis was used to synthesise data. Six key themes were identified relating to relationships and communication, information, involvement and decision-making, poor support, fragmented systems and power-over and discriminatory cultures. Impacts on MHSC service users included stress, distress, disempowerment and deterioration in mental health. We discuss our findings and indicate future research priorities.
‘I have enough pressure as it is, without the worry of doing something wrong because of ignorance’: The impact of Covid-19 on people who employ social care personal assistants
Authors: Leverton Monica , Samsi Kritika , Woolham John , Manthorpe Jill
Published: December 2022

People with care and support needs were often badly affected by Covid-19, although the impact on people employing Personal Assistants (PAs) has not been addressed. We aimed to explore the experiences of people employing PAs during the pandemic to inform care systems and social work practice. Remote qualitative interviews were conducted with seventy PA employers across England in 2021–2022. Data were analysed thematically to explore salient themes. The Covid-19 pandemic elucidated role tensions of PA employers: Navigating care arrangements during a time of unprecedented uncertainty reinforced participants’ role as an employer, but exposed some aspects of employment responsibilities and legal obligations that participants felt ill-equipped to manage. Reports of contact with or by social workers were few and not perceived as helpful. The often-informal nature of PA arrangements and its blurred relational boundaries affected participants’ expectations of their PAs. PA employers would welcome support from social workers in their employment role and flexibility with care plans, albeit with greater autonomy over their Direct Payment (DP) budget to enhance the potential of this arrangement. In the context of declining DP uptake in England, our study offers some potential explanations for this, with suggestions for systemic change and social work practice.
When the Neighboring Village is Not Treated: Role of Geographic Proximity to Communities Not Receiving Mass Antibiotics for Trachoma
Authors: Mosenia Arman , Haile Berhan A , Shiferaw Ayalew , Gebresillasie Sintayehu , Gebre Teshome , Zerihun Mulat , Tadesse Zerihun , Emerson Paul M , Callahan E Kelly , Zhou Zhaoxia , Lietman Thomas M , Keenan Jeremy D
Published: December 2022

Background

Mass administration of azithromycin is an established strategy for decreasing the prevalence of trachoma in endemic areas. However, nearby untreated communities could serve as a reservoir that may increase the chances of chlamydia reinfection in treated communities.

Methods

As part of a cluster-randomized trial in Ethiopia, 60 communities were randomized to receive mass azithromycin distributions and 12 communities were randomized to no treatments until after the first year. Ocular chlamydia was assessed from a random sample of children per community at baseline and month 12. Distances between treated and untreated communities were assessed from global positioning system coordinates collected for the study.

Results

The pretreatment prevalence of ocular chlamydia among 0 to 9 year olds was 43% (95% confidence interval [CI], 39%-47%), which decreased to 11% (95% CI, 9%-14%) at the 12-month visit. The posttreatment prevalence of chlamydia was significantly higher in communities that were closer to an untreated community after adjusting for baseline prevalence and the number of mass treatments during the year (odds ratio, 1.12 [95% CI, 1.03-1.22] for each 1 km closer to an untreated community).

Conclusions

Mass azithromycin distributions to wide, contiguous geographic areas may reduce the likelihood of continued ocular chlamydia infection in the setting of mass antibiotic treatments.
Stratification mechanisms in labour market matching of migrants
Authors: Burnazoglu Merve
Published: December 2022

I aim to challenge the standard framework in which systematic exclusion is mistakenly characterised as only a frictional phenomenon that fails to be captured in migrants’ labour market matching mechanisms. Societies organise and rank people in a hierarchical way, not only in terms of individual differences and characteristics but with respect to social groups and categories of people. These macro patterns systematically subject some migrant groups to different forms of exclusion. Social stratification, explained in terms of social identity-based institutional structures, organises labour markets into different destinations like clubs with sharply different sets of opportunities. It functions like a trap for migrants: it reinforces itself by reproducing systems of exclusion and creates dilemmas for migrants. Can migrants organise themselves to avoid such traps? I show that exclusion is endogenous to employment as a type of good in the standard goods typology. Treating different types of employment opportunities as being like clubs, I investigate how migrants join or create alternative employment clubs as a response to real or perceived exclusion from native employment clubs. If these alternative clubs are ‘sticky’ and discourage migrants from trying to join natives’ exclusive employment clubs, the trap becomes inescapable. For migrants to escape the stratification trap, employment should be seen not only as an investment but as a collective action problem structurally targeting exclusion.
A review of supportive care for older people with advanced chronic kidney disease
Authors: FitzGerald Ted J , Joosten Hanneke , van Buren Marjolijn , Vinen Katie , Brown Edwina A
Published: December 2022

Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focusing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognizing that frailty, multi-morbidity and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritize quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD.
Digital health interventions in chronic kidney disease: levelling the playing field?
Authors: Graham-Brown Matthew P M , Smith Alice C , Greenwood Sharlene A
Published: December 2022

Digital health interventions (DHIs) have long been thought of as a convenient way to deliver aspects of healthcare and broaden access to services. For patients with chronic kidney disease (CKD), DHIs designed to improve health literacy, self-efficacy and health-related behaviours such as physical activity, diet and adherence have been developed and are being tested, but their translation into clinical practice will be challenging. While DHIs potentially have broad reach, it is increasingly clear that patients from lower socio-economic and educational backgrounds, minority ethnic groups, elderly patients and those who face digital poverty are the least likely to access and benefit from DHIs, when they are precisely the patients who stand to gain the most. This article discusses the potential for DHIs to level the playing field for patients with CKD as well as the steps researchers, clinicians and developers should consider ensuring DHIs are developed, in collaboration with patients, to be inclusive and effective, as well as strategies that should be considered during development to support translation into practice.
The functional significance of residual yolk in lizards
Authors: Guo Kun , Wang Cai-Feng , Du Yu , Qu Yan-Fu , Braña Florentino , Ji Xiang
Published: December 2022

Residual yolk is assumed to be an important source of energy and nutrients during early life in nonmammalian amniotes. Available data show that the mean size of residual yolk is far smaller in lizards than in turtles, snakes, crocodiles, and birds, raising a question of whether residual yolk is of functional significance in lizards. Here, we compared data from 26 lizard species with those from other nonmammalian amniotes to test the hypothesis that residual yolk is functionally less significant in species producing more fully developed offspring. In our sample, species mean offspring water contents ranged from 73% to 84% of body wet mass; species mean proportions of carcass dry mass, fat-body dry mass, and residual yolk dry mass to offspring dry mass ranged from 84% to 99%, 0% to 5.0%, and 0% to 14.4%, respectively. Lizards are, on average, more fully developed at hatching or birth than snakes, as revealed by the fact that the mean proportion of carcass dry mass to body dry mass and offspring water contents were both higher in lizards than in snakes. We conclude that the functional significance of residual yolk during early life is generally less evident in lizards. Even in the lizards where residual yolk is of potential functional significance, this portion of yolk contributes little, if any, to postembryonic growth. Future work could usefully collect data across a wider spectrum of reptile taxa to establish a precocial–altricial continuum and test the hypothesis that species with a smaller amount of residual yolk are closer to the precocial end of the continuum.
Early mobilization after esophageal cancer surgery: a retrospective cohort study
Authors: Schuring N , Geelen S J G , van Berge Henegouwen M I , Steenhuizen S C M , van der Schaaf M , van der Leeden M , Gisbertz S S
Published: December 2022

A key component of the Enhanced Recovery After Surgery pathway for esophagectomy is early mobilization. Evidence on a specific protocol of early and structured mobilization is scarce, which explains variation in clinical practice. This study aims to describe and evaluate the early mobilization practice after esophagectomy for cancer in a tertiary referral center in the Netherlands. This retrospective cohort study included data from a prospectively maintained database of patients who underwent an esophagectomy between 1 January 2015 and 1 January 2020. Early mobilization entailed increase in activity with the first target of ambulating 100 meters. Primary outcomes were the number of postoperative days (PODs) until achieving this target and reasons for not achieving this target. Secondary outcomes were the relationship between preoperative factors (e.g. sex, BMI) and achieving the target on POD1, and the relationship between achieving the target on POD1 and postoperative outcomes (i.e. length of stay, readmissions). In total, 384 patients were included. The median POD of achieving the target was 2 (IQR 1–3), with 173 (45.1%) patients achieving this on POD1. Main reason for not achieving this target was due to hemodynamic instability (22.7%). Male sex was associated with achieving the target on POD1 (OR = 1.997, 95%CI 1.172–3.403, P = 0.011); achieving this target was not associated with postoperative outcomes. Ambulation up to 100 m on POD1 is achievable in patients after esophagectomy, with higher odds for men to achieve this target. ERAS pathways for post esophagectomy care are encouraged to incorporate 100 m ambulation on POD1 in their guideline as the first postoperative target.