bluuebunny/crossref_metadata_2025 huggingface dataset:
HPB P29 Improving the management of pain and cachexia in pancreatic cancer: Development of a patient-centred evidence-based pathway
Authors: Postaleniec Emilia , Roberts Danielle , Puthiyakunnel Saji Alwin , Selvakumar Jashan , Haghighat Ghahfarokhi Mahta , Davidson Brian , Gurusamy Kurinchi
Published: November 2023

Background

Incidence of pancreatic cancer is increasing worldwide and is likely to become the third commonest cause of cancer death in UK by 2030. Approximately 75% of people with pancreatic cancer suffer with pain and over 50% have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding management of these distressing symptoms. We aim to identify the best interventions through systematic reviews and meta-analyses; and then will perform surveys and focus groups to reach a consensus in development of a care pathway that is acceptable to patients and ready to assess for feasibility of introduction in NHS.

Methods

We will compare the relative benefits and harms of different interventions for pain in unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews (SR) and network meta-analysis. Data obtained will feed into two online surveys. (1) Patients/carers will rank interventions (identified from SR) in order of preference/acceptability. (2) Healthcare professionals will score interventions (identified from SR) on scale 1-10 according to feasibility of delivery in NHS. Four focus groups will be conducted to evaluate findings and discuss areas of contention, to enable consensus in the development of the care pathway.

Results

Project is currently in progress. Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022 (CRD42022333239/CRD42022333241). Approval by University College London Research Ethics Committee (23563/001) was received in December 2022. Data analysis is underway, expected to end by October 2023. Surveys and focus groups will be conducted thereafter. The online surveys will be primarily distributed via Pancreatic Cancer UK, but website links will also be made available on the PROSPERO records. The project is due to end in April 2024 and results will be published within 12 months of project completion.

Conclusions

This will be the first systematic review and network meta-analysis on these topics, thus enabling multiple treatment comparisons, additive effects and interaction models for different treatment combinations. We will also identify gaps in existing research that cause uncertainty in decision-making in management of pain and cachexia in pancreatic cancer. Through the surveys and focus group discussions, key stakeholders including patients, carers, and healthcare professionals, will facilitate the development of an evidence-based care pathway, ensuring both end-user acceptability and feasibility of delivery within NHS. Findings will be disseminated through patient group websites, conferences, and publication, irrespective of results, in peer-reviewed journals.
HPB P42 Case Report: Laparoscopic Cholecystectomies in patients with a Ventriculoperitoneal shunt: key considerations for surgeons
Authors: Ali-Qazalbash Zeeshan M , Bisset Carly N , Shahzad Khan Khurram
Published: November 2023

Background

Laparoscopic surgery has evolved to become the preferred mode of access for intraperitoneal surgery and is the gold standard approach to cholecystectomy. With the high prevalence of laparoscopic procedures to definitively treat gallstones and their associated complications, an increasing number of patients with co-morbidities are undergoing these procedures, including patients with cerebrospinal fluid (CSF) shunts in situ. These shunts pose unique challenges due to the paucity of guidelines, research and data to optimally manage these patients.

Methods

We report a case of a patient who underwent a successful, but technically challenging laparoscopic cholecystectomy whilst having a Ventriculoperitoneal (VP) shunt present. Important considerations are necessary, including the additional risks of: shunt failure and impaired CSF drainage, retrograde insufflation leading to increased intracranial pressure and herniation, and the risk of bile leak which could result in ascending meningitis (thereby making intra-operative cholangiogram a relative contraindication). We will discuss what unique measures were implemented pre-operatively, peri-operatively and post-operatively to prevent these complications, in consultation with both the patient and the wider multidisciplinary healthcare team.

Results

A 39-year-old female with gallstone pancreatitis, underwent an ERCP, and was subsequently listed for elective laparoscopic cholecystectomy. From childhood, she had a VP shunt in place for an Arnold Chiari II malformation. A literature review was conducted and a CT scan was arranged. Her case was discussed with neurosurgery, radiology, microbiology and anaesthetics, with multiple safety recommendations proposed; including US guided marking of the shunt tubing on the skin, appropriate pre-operative antibiotics, lower than normal pneumoperitoneum pressures, no attempt at intra-operative cholangiogram or bile duct exploration, avoidance of gallbladder perforation, minimal washout, neuro-observations in the post-operative period and post-operative antibiotics.

Conclusions

Our report shows that with thorough pre-operative planning involving communication with multidisciplinary team and with informed consent, laparoscopic cholecystectomy can be performed in this patient sub-group with relative safety without the need for shunt manipulation or peri-operative intracranial pressure monitoring. It is however, technically challenging, and should be considered by experienced laparoscopic surgeons, and perhaps reserved for those with subspecialty biliary interests.
HPB P43 Pancreatic Anastomosis Audit (PARANOIA): Initial experience of an international POPF registry
Authors: Pande Rupaly , Roberts Keith ,   Paranoia Study Group
Published: November 2023

Background

Post-operative pancreatic fistula (POPF) remains the primary determinant of poor outcome following pancreatoduodenectomy (PD) Risk factors are well understood but there is no apparent reduction in incidence. RCT’s are methodologically flawed to investigate POPF.

PARANOIA is a registry with two novel outcomes. 1) Surgeons-specific risk-adjusted outcomes: Surgeons will observe in real time how changes to surgical technique impact upon outcomes. By having access to the registry data surgeons can explore technical factors of pancreas surgery that are associated with high or low risk of pancreatic fistula. 2)The registry will serve as a platform for international prospective studies.

Methods

Core dataset consists of common risk factors found within scores (aFRS, FRS, Roberts’) along with anastomotic technique and adjuncts. Initial prospective studies test topical clinical questions through embedded parallel studies. Using a stepwise approach, the registry and user network will be tested with increasingly complex study designs to determine the functionality of the registry as a novel research tool. Surgeons will have their risk-adjusted outcomes as a CUSUM plot which they can compare against anonymised surgeons by different variables.

Results

232 registered surgeons across 56 countries with 776 cases. Majority of surgeons are performing open surgery (open 208 (89.7%) vs laparoscopic (11 (5.2%) vs robotic 11 (5.2%)). End-to-side was the commonest technique (88.8%) with invagination (69%) being used more than duct-to-mucosa (31%). 43.5% of surgeons used an internal stent routinely and almost all used drains (97.8%). 13% used pharmaceutical sealants whereas 28.4% used an autologous barrier. 44% used a somatosatin analogue (SSA). 70.5% reported no POPF whereas 8.4% had a CR-POPF rate. A reduced CR-POPF was associated with use of stent (p=0.008), autologous barrier (p=0.012) and SSA (p=0.049).

Conclusions

The PARANOIA registry has shown rapid recruitment of surgeons and data entry in pancreatic surgery can not only shorten the timeframe from study conception to dissemination of results but also provide real world data and provide comparison of outcomes between and within geographical regions, a key factor given that some patient and operative variables relevant to POPF vary across the globe. Registry data and the risk-adjusted CUSUMS can be used by surgeons to benchmark themselves against their peers and consider how modifications to their operative technique or perioperative care may affect their outcomes.
HPB P54 First Reported Case of Primary Serous Cystadenocarcinoma of the Spleen
Authors: Sciberras Peter , Wilkins Alexander , Baitule Amey , Buchanan Alex
Published: November 2023

Background

Tumours of the spleen are uncommon, and the majority are metastases from primary malignancies in other organs. The two main subdivisions of primary malignancies of the spleen are lymphoid and non-lymphoid. Primary splenic cystadenocarcinomas are extremely rare, and only tumours of the mucinous subtype have been recorded. The spleen usually exhibits secondary infiltration from primary cystadenocarcinomas in other organs such as the ovaries and pancreas.

Methods

We present the case of an elderly white female who was found to have an incidental splenic tumour. This showed interval increase in size on serial imaging and was confirmed to be a complex mass with a cystic component on MRI. After MDT discussion and further investigations, including FDG-PET, EUS and diagnostic laparoscopy, she underwent a distal pancreatectomy, partial gastrectomy and splenectomy for a presumed tail of pancreas adenocarcinoma.

Results

The splenic hilum contained a large partly cystic tumour conglomerate measuring up to 5.8cm in maximum dimension, which contained thick, dark red, gelatinous material. It was well-circumscribed and demarcated from the rest of the splenic parenchyma, and the distal pancreas appeared to be uninvolved. Histology showed low columnar to cuboidal cells with moderate to patchy marked nuclear pleomorphism, and no cytoplasmic mucin was identified. The tumour had a predominantly papillary and focal tubular architecture, with hierarchical branching of papillae. The neoplastic cells stained positive for CK7, ER and WT1 expression and negative for CK20 and CA.

Conclusions

Histological and immunohistochemical analyses were consistent with the first recorded case in the literature of primary serous cystadenocarcinoma of the spleen, which we believe developed through malignant transformation of a benign epidermoid cyst. This is the commonest type of true cysts of the spleen and one which has tumorigenic potential, being able to undergo metaplasia and dysplasia. The patient remains well as per her latest follow-up with no evidence of recurrence or metastases. However, given the rarity of splenic cystadenocarcinomas, uncertainty remains on the long-term prognosis and optimal management of such cancers, including adjuvant treatment options.
HPB P59 An evaluation of local 30-day readmissions following laparoscopic cholecystectomy
Authors: Hussain Muhammad , Asarbakhsh Mariam , Gautam Singh , Jamie Routledge , Wijayendran Anusan , Sowemimo Sinmidele , Saha Arin
Published: November 2023

Background

Laparoscopic cholecystectomy, both elective and acute, is a commonly performed operation in general surgery. Good post-operative outcomes are important for patient physical and mental wellbeing. For example, complications can result in physical harm and abdominal pain can cause distress and anxiety. Patient anxiety can also result from symptoms which may not have a clinically significant or concerning cause. 30-day hospital readmission rates post-surgery are considered by some as a measure of quality of care. This study assessed 30-day readmissions following laparoscopic cholecystectomy at our local hospital and the investigation and management of these.

Methods

Clinical patient data software was used to obtain the details of all patients undergoing acute and elective laparoscopic cholecystectomy over a 4 month period, from January 2022 to the beginning of May 2022. Pre-, intra- and post-operative data was collated. Post-operative data incorporated the presenting complaints, investigations and management of patients re-presenting within 30 days of discharge from our hospital.

Results

150 laparoscopic cholecystectomies were performed over 4 months. There were 12 30-day readmissions (8%), 4 elective and 8 acute patients. Presenting complaints included abdominal and chest pain. Investigations included blood tests (10 patients, 83%), ultrasound abdomen (1 patient, 8.3%), CTAP or CTPA (7 patients, 58.3%), and MRCP (1 patient, 8.3%). CTPA scans were negative for pulmonary emboli. 3 patients (2%) with gallbladder fossa collections were discharged with antibiotics. 2 patients (1.3%) required re-laparoscopy and washout in theatre for bile leak (no CBD injury). 1 patient (8.3%) required ERCP for a distal CBD stone. Overall, 4 patients (2.7%) required inpatient admission.

Conclusions

This study found that only a third of patients reattending within 30 days required inpatient admission, which was not unexpected. However, although most patients did not require admission, arguably the investigations performed were essential to establish this. For example, although CTPA scans did not reveal pulmonary emboli, this was a necessary investigation in the post-operative obese patient with chest pain. That said, a more effective system of triage, for example face-to-face evaluation by GPs or A&E doctors and avoidance of surgical referral without clinical assessment, is suggested to prevent inappropriate referrals, such as antibiotic skin reactions and wound bruising.
OGC P06 Oncological outcomes of patients with oligometastatic oesophagogastric cancer
Authors: Down Billy , Lakunina Svetlana , Markar Sheraz , Gordon-Weeks Alex
Published: November 2023

Background

A recent international expert consensus defined oligometastatic oesophagogastric cancer as the presence of no more than two liver, lung, retroperitoneal lymph node, adrenal, soft tissue or bone metastases and an 18-week period of oncological stability during chemotherapy. The number of patients who fit this criterion and whether their oncological outcome differs from those with multi-metastatic disease is unknown.

Methods

We analysed our prospectively maintained database of consecutive patients with synchronous or metachronous metastatic oesophagogastric cancer from January 2017 to December 2021. The primary outcome was median overall survival (OS).

Results

We included 502 patients with 120 patients (24%) metachronous metastases following surgical resection of primary tumour and 382 (76%) with synchronous metastases. 36 (7.2%) had oligometastatic disease. For patients with metastases at diagnosis, median OS was 7.3 months for the multi-metastatic group versus 26.8 months for patients with oligometastasis(p<0.0001). For metachronous disease, median OS in multi-metastatic groups was 6.1 months versus 38.6 months for patients with oligometastasis(p<0.0001). 35% of patients with metachronous oligometastatic disease underwent surgical management of their metastasis. This group demonstrated improved median OS versus those receiving systemic treatment alone (>60 months versus 24.4 months; p<0.038).

Conclusions

Oligometastatic oesophagogastric cancer is associated with improved oncological outcome when compared to multi-metastatic disease. Further work is needed to identify patients who will benefit from aggressive treatment of metastatic oesophagogastric cancer.
OGC P16 Pancreatic Exocrine Insufficiency after Oesophagogastric Resection: Results from a Systematic Review and Meta-Analysis
Authors: Hall Lewis , Powell-Brett Sarah , Halle-Smith James , Ward Liz , Wiggins Tom , Markar Sheraz , Roberts Keith
Published: November 2023

Background

Unpleasant gastrointestinal complications can affect 9/10 patients after oesophagogastric resection (OGR), and malnutrition is recognised in this cohort. Untreated pancreatic exocrine insufficiency (PEI) results in substantial patient harm and is recognised as a contributor to such symptoms. The incidence of post-operative PEI is unclear, however and the benefit of management with pancreatic enzyme replacement therapy (PERT), rarely discussed. The aim of this study was to assimilate the literature on incidence, diagnosis, and management of PEI in patients following OGR.

Methods

A systematic review of PUBMED and Embase databases identified studies investigating PEI following OG resection. A pooled analysis was performed to determine prevalence of PEI in each cohort, and benefit of PERT. Meta-analyses were performed using the software package Revman 5.4, in accordance with the recommendation of the Cochrane Collaboration.

Results

Twelve studies were included in the quantitative synthesis of PEI rate after OGR surgery. The rate of PEI after any OGR was 50.4% (95% CI: 38.3% - 62.6%) amongst 463 patients. PEI was most prevalent after total gastrectomy at 66.2% (95% CI: 44.9% - 84.9%) followed by subtotal, 46.9% (95% CI: 33.3% - 60.9%) and oesophagectomy 31.0% (95% CI: 17.0% - 46.9%) The most common diagnostic test used was faecal-elastase-1 (FE-1) (4/12 studies) reporting <200 µg/g as diagnostic of PEI. Four studies reported the effect of PERT, with symptomatic benefit seen in 75.2% (95% CI: 66.9% - 82.7%).

Conclusions

PEI is common following OGR, with over half of patients developing PEI. The presence of PEI reduces quality of life, contributes to malnutrition and long-term poor health, but can be managed effectively with PERT. Future work must further define the role of PERT after OGR, considering not only nutritive and qualitative benefit, but also whether a survival advantage is conferred.
OGC P19 Peritoneal metastases from gastric cancer in a nationwide cohort: incidence, treatment and survival
Authors: Rijken Anouk , Pape Marieke , Simkens Geert , de Hingh Ignace , Luyer Misha , van Sandick Johanna , van Laarhoven Hanneke , Verhoeven Rob , van Erning Felice
Published: November 2023

Background

The aims of this study were to investigate incidence, risk factors and treatment of synchronous or metachronous peritoneal metastases (PM) from gastric cancer and to estimate survival of these patients using population-based data.

Methods

Patients diagnosed with gastric cancer in 2015-2016 were selected from the Netherlands Cancer Registry. The incidence of synchronous and metachronous PM were calculated. Multivariable regression analyses were performed to identify factors associated with the occurrence of PM. Treatment and survival were compared between patients with synchronous and metachronous PM.

Results

Of 2147 patients with gastric cancer, 656 (31%) were diagnosed with PM. Of these, 498 (23%) had synchronous PM. The cumulative incidence of metachronous PM in patients who underwent potentially curative treatment (n=675) was 22.8% at 3 years. A factor associated with synchronous and metachronous PM was diffuse type histology. Patients diagnosed with synchronous PM more often received systemic treatment than patients with metachronous PM (35% vs. 18% respectively, p<0.001). Median overall survival was comparable between synchronous and metachronous PM (3.2 vs. 2.3 months respectively, p=0.731).

Conclusions

Approximately one third of all patients with gastric cancer are diagnosed with PM, either at primary diagnosis or during 3-year follow-up after potentially curative treatment. Patients with metachronous PM less often received systemic treatment than those with synchronous PM but survival was comparable between both groups. Future trials are warranted to detect gastric cancer at an earlier stage and to examine strategies that lower the risk of peritoneal dissemination. Also, specific treatment options for patients with gastric PM should be further investigated.
OGC P21 Discrepancy between the clinical and final histopathological staging of locally advanced oesophageal adenocarcinoma
Authors: Hraishawi Ihab , Deeny Dearbhla , Gray Ronan , McCain Scott , Harris Andrew , MacAulay Graeme , Kennedy Raymond , Kennedy Andrew
Published: November 2023

Background

Accurate staging of locally advanced oesophageal cancer plays a pivotal role in treatment planning and prognostic counselling for the patients. Clinical staging employs various imaging modalities to guide treatment decisions and predict outcomes. This study aimed to compare clinical staging (post neoadjuvant chemotherapy) with the final histopathological staging in patients with locally advanced oesophageal adenocarcinoma undergoing oesophagectomy at Belfast Health and Social Care Trust.

Methods

A retrospective analysis was conducted on a cohort of 81 patients diagnosed with locally advanced oesophageal adenocarcinoma who underwent neo-adjuvant chemotherapy followed by oesophagectomy at Belfast Trust between March 2020 and March 2022. Patients with squamous cell carcinoma, those who proceeded directly to surgery and those treated with salvage oesophagectomy following previous radical chemo-radiotherapy were excluded from the study to minimise heterogeneity. Two independent radiologists reviewed the restaging PETCT scans and validated the clinical staging. The post neoadjuvant clinical staging was subsequently compared to the final histopathological staging obtained from surgical resection specimens.

Results

Among the 81 patients included in this study, a significant proportion of patients were upstaged (53%) or downstaged (31%). The combined T&N staging accuracy was observed in only 13 patients (16%). 21 patients (26.3%) had their T staging downstaged on final assessments. Nodal staging discrepancies were observed in 35 cases (43.2%) upon final histopathological assessment. These isolated nodal discrepancies primarily involved nodal upstaging, with 14 patients upstaged from N0 to N1 and 13 patients upstaged from N0 to N2.

Conclusions

The accuracy of clinical staging for oesophageal adenocarcinoma remains poor. Our study revealed notable discrepancies in nodal staging between clinical and final histopathological staging. Approximately 43.2% of patients had isolated nodal discrepancies, primarily involving nodal upstaging. These findings emphasize the challenges in accurately assessing nodal involvement and highlight the need for improved staging methods to guide optimal treatment for locally advanced oesophageal adenocarcinoma. The topic of whether the routine use of EUS is justified for evaluating regional lymphnodes and enhancing staging remains a subject of debate, notwithstanding the limitations and challenges inherent to EUS.
OGC P30 Prophylactic HIPEC and Intro-Operative Radiotherapy (IORT) in the Management of Gastric Cancer: An international retrospective case-control study
Authors: Aldaghiri Khalid , Worthington Lucy , Alyahya Zyad , Alkhaffaf Bilal
Published: November 2023

Background

The combination of surgery and peri-operative chemotherapy is a well-established cornerstone of treatment with curative intent for gastric cancer in the UK. However, this approach has not necessarily been adopted globally. Hyperthermic intraperitoneal chemotherapy (HIPEC) and intraoperative radiation therapy (IORT) may improve survival amongst patients with advanced gastric cancer, however the evidence base for its use is limited and its efficacy remains unclear. The present study investigated the effectiveness of prophylactic HIPEC and IORT compared to peri-operative chemotherapy and gastrectomy in patients with gastric cancer.

Methods

A retrospective study including patients with gastric adenocarcinoma (stages 1-3) between 2014 and 2020 was undertaken. All patients received peri-operative chemotherapy and radical gastrectomy in an academic surgical centre in the Kingdom of Saudi Arabia or a regional tertiary oesophago-gastric centre in the North-West of England. Two groups were formed – one (study group – KSA; HIPEC-IORT) which also received combined prophylactic HIPEC and IORT and one which did not (control – UK; CS). Three parameters were utilized as control variables (age, gender, tumour stage and location). 2:1 matching between the control and study group (86 vs 43 patients) was performed.

Results

Mean age was 60 (SD = 14.5; 81.5% male). R0 rates were 74.5% in the HIPEC-IORT group vs 82.5% in the CS group. LVI and PNI rates were higher in the HIPEC-IORT group (55.8% vs 32.6%)(55.8% vs 32.6%) as were rates of diffuse-type morphology (39.5% vs 17.5%). Pathological stage distribution in the study group was different (37.2% II and 62.8% III) vs (31.4% I, 34.9% II, 33.7% III). Cox regression analysis which controlled for age, gender, and cancer stage, found no difference in survival between HIPEC-IORT and CS groups (p=0.219).

Conclusions

The findings of the present study suggest that the combination of prophylactic HIPEC and IORT following radical gastrectomy cancer does not significantly improve survival. Further exploration which compares the short-term outcomes of both approaches is required. These results should be interpreted with caution as the groups showed morphologically different tumour-types. A larger prospective study which controls for more variables may be warranted.
OGC P32 Preoperative hand grip strength is associated with postoperative pulmonary complications after major abdominal surgery: a prospective multi-centre international cohort study
Authors: Sellayah Renishka , Boden Ianthe
Published: November 2023

Background

Low muscle strength is a primary indicator of sarcopenia, defined by the European Working Group on Sarcopenia (EWGSOP2) and is related to postoperative complications after major surgery. Handgrip strength is easily measured preoperatively and is an alternative to skeletal muscle index assessments, which are time consuming and require specialised equipment. The current studies pertaining to handgrip and postoperative outcomes are largely retrospective, single-centre studies in populations dissimilar to Australian and New Zealand surgical patients.

Methods

Patient-level data from the Lung Infection Prevention Post Surgery – Major Abdominal – with Pre-Operative Physiotherapy study (ANZCTR 12613000664741), a randomised controlled trial conducted across three Australian and New Zealand tertiary hospitals (2013-2015) was utilised. Eligible patients were those listed for elective upper abdominal surgery. Maximum dominant handgrip was measured via standardised methods. Percentage of predicted handgrip was calculated using recognised normative values; <85% predicted was set as signifying low handgrip strength. The association between <85% of predicted handgrip and postoperative outcomes was analysed using multivariate regression modelling adjusted for covariate effects of age, gender, ASA, smoking status, and type of surgery.

Results

Of 432 participants (50% colorectal, 25% UGI/HPB) hand grip data was available for 379 (88%). Patients with low preoperative handgrip had a four-fold increased risk of developing a postoperative pulmonary complication (RR 3.95; 95% CI 1.09 to 14.2; p=0.037) independent of other confounding variables. Handgrip had the strongest effect on postoperative pulmonary complications compared to age, gender, upper gastrointestinal, hepatobiliary surgery, ASA, and current smoking. There were consistent signals of a relationship between preoperative weak hand grip and MET calls, extraordinary physician ward consults, prolonged length of hospital stay (>14 days), sub-acute stays, and longer time to independent mobilisation.

Conclusions

This is the first study of handgrip in Australian and New Zealand surgical patients. It prospectively validates previous findings that weak handgrip is related to worse postoperative outcomes, particularly respiratory. Intriguingly, handgrip had a stronger effect on pulmonary complications than upper GI or hepatobiliary surgery. Finally, given its ease of measurement, handgrip can be assessed at first clinical contact, increasing the time available for pre-habilitation.
OGC P37 Long term follow-up of patients undergoing prehabilitation prior to oesophagectomy: What happens to patients declining or withdrawing from prehabilitation exercise programmes?
Authors: Knight William , Moore Jonathan , Whyte Greg , Zylstra Janine , Lane Andy , Pate James , Gervais-Andre Louise , Maisey Nick , Hill Mark , Tham Gemma , Lagergrens Jesper , Kelly Mark , Baker Cara , Van Hemelrijck Mieke , Goh Vicky , Gossgae James , Browning Mike , Davies Andrew
Published: November 2023

Background

Prehabilitative exercise prior to cancer surgery can improve survival, health-related quality of life and chemotherapy completion and response rates. Little is known about patients who either drop-out or decline to participate in exercise programmes in oesophageal cancer. This study reports the outcomes of patients who declined or dropped out of the Pre-EMPT trial prior to neo-adjuvant chemotherapy (NAC) and oesophago-gastrectomy.

Methods

A prospective non-randomised, cohort-controlled trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal cancer. Kaplan-Meier and multivariable Cox regression analyses were used to compare overall and disease-free survival between the trial patients (intervention and control) with patients who declined participation or dropped out of the study (non-participants).

Results

21 patients completed the exercise intervention, 20 patients were enrolled in the control group, and 24 patients either dropped out (9) or declined to participate (15). All underwent NAC and oesophago-gastrectomy. Baseline comorbidity, post-operative complication rates and length of stay were similar between all groups. Kaplan Meier survival analysis showed no difference between the intervention and control groups but a significant survival disadvantage in the non-participants (p=0.03). On multivariable analysis mortality hazard ratio was significantly higher in the non-participant group (HR 95%CI3.44; 1.05-11.28).

Conclusions

Patients who dropped out or declined to participate in the PRE-EMPT study experienced poorer survival compared to both the intervention and control groups. This survival disadvantage is likely to be multifactorial. However, these patients represent an important group, currently inaccessible to prehabilitative programmes, who may have the most to gain from such an intervention.
OGC P40 An exploration into the duration patients undergoing surgical resection of Oesophageal or Gastric cancers require specialist Upper Gastrointestinal dietetic support
Authors: Dossou Vida
Published: November 2023

Background

Patients recovering from UGI resection are nutritionally complex, vulnerable, and face multiple dietetic challenges. Surgical guidelines exist in terms of gold standard follow up for UGI Cancer patients in UGI surgical clinics, however currently there is no guidance on how long they require intensive, specialist UGI dietetic support. Disparity exists amongst surgical centres in terms dietetic resource and service provision, thus no guideline on how long to keep under the tertiary UGI dietetic care currently exists. As an established, regional, UGI surgical dietetic service, an audit was conducted discerning the specialist UGI dietetic need for 5 years post resection.

Methods

A retrospective audit was conducted observing follow up of patients undergoing UGI surgery at a tertiary centre for UGI surgery in 2018. All patients had undergone Oesophagogastrostomy (OG), Total Gastrectomy (TG), or Sub-Total Gastrectomy (STG) and were under the care of the UGI RD by means of a blanket referral system. Patients were followed up by UGI surgery for 5 years. Electronic patients’ records were utilised, and the following information was collected per patient: Type of surgery, Number of dietetic contacts, Duration of follow up, Type of diet. This was collated, type of diet was compared, and average values obtained.

Results

Our results demonstrated that UGI surgical patient’s require significant specialist UGI RD follow up post resection regardless of the type of surgery. In terms of complexity, OG patients were most challenging with multiple dietetic interventions at the same time to meet nutritional needs and manage malabsorption. In all cases, the most prevalent intervention was using diet and Oral Nutritional Support. Surprisingly, STG required the longest dietetic follow up at almost double that of TG. OG patients required the second longest duration of specialist UGI dietitian follow up, however the most dietetic contacts, reiterating that their input was more intensive.

Conclusions

This audit identifies the need for specialist, frequent UGI dietetic support for at least 31/2 years post UGI resection, ideally at an experienced tertiary surgical centre. Whilst OG patients require more intensive dietetic support, TG and STG also have an equally long-term dietetic need. This data spreads across the pandemic period, therefore opportunities for follow up may have been impacted, thus this data could be an underreporting. It would be prudent to repeat this audit on post pandemic resections to ascertain if more frequent, longer term UGI dietetic review is observed. Further audit should include readmission rates, and patient feedback.
OGC P44 Biospectrometry as a non invasive tool in the diagnosis of oesophageal cancer
Authors: Elniel Mohammed , Maitra Ishaan , Ur Rehman Ihtesham , Daté Ravindra
Published: November 2023

Background

Oesophageal adenocarcinoma (OAC) typically presents at an advanced stage with resultant poor survival rates. The 2022 oesophago-gastric (OG) audit suggests only 35.9% of patients diagnosed with OG cancer were treated with curative intent.

Raman spectroscopy of serum is a non-invasive and rapid diagnostic technique which has proved promising in cancer diagnostics. A proof-of-concept study of 124 samples undertaken by our team to determine the accuracy of Raman spectral discrimination in detecting oesophageal transformation of Barrett’s to adenocarcinoma revealed sensitivity and specificity of over 95% when using serum to diagnose OAC.

Methods

Our research group has conducted a further study to validate the aforementioned findings by re-analysing 60 samples from the proof of concept study in a separate laboratory. Chemometric techniques, coupled with principal component analysis, were employed to identify discriminant spectral peaks. Subsequently, a prediction model was developed using a linear discriminant analysis algorithm to accurately classify serum samples from cancer patients.

Results

Spectral peaks representing methylene deformation at 1450 cm-1 and C-O stretch of ribose at 1012 cm-1 were identified as discriminant spectral peaks in identifying OAC in both analyses, inferring that these results are reproducible. A specificity and sensitivity of 72% and 71% respectively was calculated from chemometric spectral analysis.

Conclusions

We conclude that Raman spectroscopy has potential applications as a non-invasive screening tool for patients with suspected OAC.
OGC P46 A consensus opinion on the best prehabilitation strategies for Upper GI cancer patients
Authors: Moody Negar , Moody Paul , Mahmood Fahad , Veenith Tonny , Tan Benjamin
Published: November 2023

Background

Upper GI (UGI) cancer patients face substantial physical and functional challenges which can compromise postoperative recovery. Prehabilitation, a proactive multidisciplinary intervention, offers a promising approach to optimize patient outcomes. This Delphi exercise aims to gather a consensus on the effectiveness of various prehabilitation strategies and interventions in improving functional capacity, reducing treatment-related complications, and enhancing quality of life among UGI cancer patients.

Methods

We performed a Delphi exercise in the form of an online survey emailed to a group of surgeons, anaesthetists, specialist nurses and allied healthcare professionals involved in the perioperative care of UGI cancer patients. A 2-staged iterative process was used to gather consensus on clinical practice and expert opinion. In the second round the survey was refined to evaluate specific strategies of prehabilitation more closely.

Results

In the first round, 14 statements were evaluated in addition to basic demographic data, information about the unit and clinician experience. 161 responses were collected from surgeons, anaesthetists, specialist nurses and allied healthcare professionals. Consensus was reached on formal assessment of patient fitness pre-operatively. However no consensus was achieved in the best method for doing so. In the second round we evaluated 22 statements after refining the questions to specifically target prehabilitation exercises and formal fitness assessments available for the perioperative care of UGI cancer patients.

Conclusions

Prehabilitation interventions hold significant potential in optimizing outcomes and improving the quality of life for UGI cancer patients undergoing major surgery. This Delphi exercise provides multidisciplinary expert consensus statements which can help guide clinicians in day-to-day practice as well as provide a basis for future guidelines and recommendations.
OGC P47 Yield of staging laparoscopy in upper GI cancer; post COVID
Authors: Ahmed Salman , Shetty Vinutha , Ward Jeremy , Singh Mohan , Turner Paul , Pursnani Kish
Published: November 2023

Background

Staging laparoscopy is a useful adjunct in preoperative staging process of oesophago-gastric cancer. NICE recommends use of staging laparoscopy in oesophageal cancer cases where it is likely to guide further management. In cases of gastric cancer there is strong evidence to suggest a high specificity of staging laparoscopy in detection of peritoneal metastasis. During COVID very selective use of staging laparoscopy was adopted by our unit. In this study we aimed to evaluate yield of staging laparoscopy in context of gastric and selective oesophageal cancers in our unit during post-COVID period

Methods

Retrospective analysis of our prospectively kept database in patients undergoing staging laparoscopy between January 2022 to May 2023 in upper GI tertiary cancer centre was performed. Age, sex, tumour grade, nodal status on radiology, histologic type, differentiation, and site of tumour was assessed against positive cytology and presence of peritoneal or occult visceral metastasis. Multivariate logistic regression was applied to identify independent factors associated with findings. Statistical analysis was carried out using EXCEL® and MedCalc® software.

Results

Among 104 patients, 69 had oesophageal cancer (OC) and 35 had gastric cancer (GC). In OC group cytology was positive in 4 (5.8%), peritoneal metastasis was present in 7 (10.1%) patients. In GC group positive cytology in 8 (22.8%), peritoneal metastasis was found in 8 (22.8%) patients. On multivariate analysis differentiation, T3+ tumour, lower third cancer, male sex was linked with positive findings in OC group. In GC group poor differentiation, T4 disease, mid body tumour, nodal status of N3 were associated positive findings. Yield of laparoscopy was found to be 17.6% and 34.6% in OC and GC groups respectively.

Conclusions

Despite of recent advances in radiological modalities, staging laparoscopy remains a useful adjunct in diagnosing peritoneal disease. With negligible complication rates and its relatively high yield in lower third and junctional oesophageal cancer it can be utilised to guide further management and reduce unnecessary laparotomies. Mid gastric body site and T4 cancers in our cohort were strong predictors of peritoneal disease further multi centre research on site of tumour is needed to affirm any such association.
OGC P48 The Relationship between Hospital Acquired Pneumonia (HAP) and Synchronous Post-Operative Complications following Oesophagectomy: An Assessment of the impact on mortality
Authors: Waheed Unaiza , Alvi Quraishi Rumaysa , Patel Minal , Worthington Lucy , Fidler David , Heal Calvin , Alkhaffaf Bilal
Published: November 2023

Background

Hospital Acquired Pneumonia (HAP) is a frequently occurring complication following oesophagectomy, often associated with poorer outcomes. After oesophagectomy, HAP can occur in conjunction with other pulmonary and non-pulmonary complications such as anastomotic leak. Single lung ventilation during oesophagectomy can lead to altered lung function, contributing to infective and non-infective respiratory complications. Understanding the interplay between these factors is crucial for recognizing the multifaceted nature of HAP and identifying areas of focus to reduce its incidence. This study aimed to quantify the incidence of HAP in relation to other complications, and assess the effect of pulmonary complications on long-term outcomes.

Methods

This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG cancer centre serving a population of 3.5 million people between 2014-2022. Data was extracted from the Electronic Patient Records. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. Clinical details and radiological reports (Computed Tomography and Chest X-Ray) on the day of HAP diagnosis (defined using the CDC criteria) were recorded, alongside evidence of pneumothorax, pleural effusion, emphysema and Acute Respiratory Distress Syndrome (ARDS). Complications were defined using the Esophagectomy Complications Consensus Group (ECCG) definitions. Survival analysis was conducted on STATA.

Results

460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP - 56 (12.2%) met the CDC criteria. 125 (60.10%) patients treated for HAP had concurrent pleural effusion, 60 (28.85%) pneumothorax, & 12 (5.77%) surgical emphysema. 53 patients (25.49%) had two concurrent findings. 17/53 (32%) patients with anastomotic leak also had HAP. 5-year OS between patients treated for HAP who met the CDC criteria versus those who did not meet the criteria were similar. There was no difference in OS between patients with HAP versus no respiratory complications. Patients with no complications had the highest 5-year survival.

Conclusions

A significant proportion of patients develop HAP after oesophagectomy, usually alongside concurrent pulmonary complications. A significantly higher number of patients were treated for HAP than met the CDC criteria, highlighting the complexity in diagnosing post-operative complications. Our results suggest that a diagnosis of HAP is not a predictor for poorer long-term survival. Further research is warranted to elucidate the underlying mechanisms and refine treatment approaches in this patient population.
OGC P51 Development of a symptom response questionnaire following therapeutic interventions for patients recovering from oesophagogastric cancer resection
Authors: Barman Sowrav , Chevallay Mickael , Evans Orla , Taylor Joanna , Dunn Jason , Baker Cara , Kelly Mark , Knight William , Gossage James , Zeki Sebastian , Davies Andrew
Published: November 2023

Background

Patients frequently experience symptoms after major oesophagogastric (OG) cancer resection which can delay quality of life resolution. Multiple symptoms can arise simultaneously making diagnosis of the underlying problem(s) and subsequent treatment complex. While diagnostic tests can offer valuable insight, some conditions are treated empirically and a positive response to therapy can go some way to confirming the diagnosis. Whilst numerous baseline symptom questionnaires exist, there is currently no established questionnaire to assess treatment response to an intervention following OG cancer surgery.

Methods

A survey of 362 OG cancer patients in survivorship phase identified their most important symptoms after surgery. A questionnaire based on validated EORTC symptom questionnaires including those derived from EORTC QLQ- CR 29, Bil 21, C30, ST022, OES 18 and OG25 has been developed to assess intervention impact on symptoms. For each reported symptom the patient is asked to grade the degree to which the symptom affected them before and after the intervention on a Likert scale.This study reports the development of the questionnaire and patient feedback following pyloric dilatation for delayed gastric emptying at 2 and 4 weeks post-procedure.

Results

The development of the questionnaire incorporated the use of previously validated EORTC questions and two measures that compared the patient’s symptoms before and after therapeutic intervention. All 12 patients involved in the initial development and first-stage review of the questionnaire rated it as easy or very easy to complete. A subsequent consecutive validation cohort of 27 patients undergoing pyloric dilatation for delayed gastric emptying also described the questionnaire as easy or very easy in 100% of cases.

Conclusions

Symptom response to an intervention is not routinely collected in a prospective setting despite potentially offering important clues as to accuracy of underlying diagnosis and documenting efficacy of the treatment. Patient recall of response to treatment retrospectively may be inaccurate and susceptible to bias. To best of our knowledge, this is the first questionnaire to detail symptomatic responses to therapeutic interventions in patients after OG cancer surgery. The questionnaire appears to be acceptable to patients and easy to complete. Further validation is needed before the questionnaire can be widely used, including testing with various interventions and on a digital platform.
OGC P52 Short and long-term outcomes of minimally versus open gastrectomy for cancer; a retrospective analysis over 15 years
Authors: Worthington Lucy , Abdullatheef Kalathil Mohammad , Al-Daghri Khalid , Alkhaffaf Bilal , Waheed Unazia
Published: November 2023

Background

Minimally invasive gastrectomy (MIG) is a well-established approach for the management of gastric cancer. However, much of the evidence base has come from the Far East where patient characteristics are significantly different and therefore not necessarily applicable to Western practice. In the UK (NOGCA 2022), less than 20% of gastrectomy is undertaken using a MIG approach with limited information regarding the distribution between total or partial MIG. This area therefore urgently requires further exploration. Our study aimed to review short and long-term outcomes of patients undergoing open and MIG over a 15-year period.

Methods

This was a retrospective analysis of all consecutive patients who underwent MIG and open gastrectomy (OG) for cancer between 2007 to 2022. The setting was a regional tertiary oesophago-gastric centre in the North-West of England serving a population of over 3.5 million people. Patients were further subcategorised into total (TG) or partial resections (PG -defined as sub-total or distal gastrectomy). Patient demographics and co-morbidities, peri-operative treatments, disease-related data, in addition to short and long-term outcomes were collected. Outcome choice was informed by the GASTROS core outcome set for surgical studies in gastric cancer.

Results

372 patients were included (OG 245; LG 105; LG converted 22). 166 underwent PG (MIG = 39.8%) and TG 187 (MIG = 18%). No difference in patient co-morbidities, staging or peri-operative chemotherapy rates between groups was found.

LOS was 15.2 days for OG and 14.4 days for LG (p = 0.220). Median lymph nodes resected was 20 for OG and 21 for LG (p = <0.004). R0 rates were 90% for OG and 94% for LG (p=0.441). Overall survival was similar (1075 days for OG vs 1114 days for LG (p=<0.751)). No differences were found in TG or PG.

Conclusions

Outcomes following MIG in this study were not statistically different to OG. This was mirrored in a sub-group analysis of total and partial gastrectomy. This data suggests that MIG is an appropriately safe alternative to open gastrectomy. Further multi-centre studies are required to validate these findings. A randomised control trial may be challenging to recruit to due to limited uptake of MIG across the UK.