bluuebunny/crossref_metadata_2025 huggingface dataset:
P-O18 Pancreatic Enzyme Replacement Therapy in Upper GI Surgery- A Retrospective Audit
Authors: Chalmers Naomi
Published: December 2021

Background

Pancreatic enzyme insufficiency (PEI) appears to be under recognised and under treated in upper GI surgery due to limited clinical data regarding the prevalence of PEI after gastric surgery, therefore potentially leading to malnutrition in an already vulnerable patient group. This retrospective audit looked at a total of 197 resections in a two year time period and aimed to determine what type of upper GI surgery pancreatic enzyme replacement therapy (PERT) was used in, if use of PERT improved malabsorption symptoms and/or nutritional markers (weight and grip strength) and finally if there was a consistent PERT dosage that was prescribed with good effect.

Methods

Retrospective audit recorded all patients that had undergone a total gastrectomy, subtotal gastrectomy, oesophagectomy, colonic interposition, palliative bypass and GIST resections between 2018-2019 that were undertaken in a regional centre for upper GI cancer surgery. Through means of patient electronic records it was recorded which of these patients started on PERT and if there was any improvement in their symptoms. Nutritional markers were recorded at specific intervals and the final dosage of PERT used with good effect.

Results

66.6% of total gastrectomies were commenced on PERT with 68.1% reporting an improvement in symptoms and 27.2% reporting some improvement. 34.7% of subtotal gastrectomies were commenced on PERT and 100% of these patients experienced symptomatic relief. 22.4% of oesophagectomies were commenced on PERT with 68% reporting an improvement in symptoms and 9% some improvement. 33% of the colonic interpositions were commenced on PERT with 100% of patients reporting an improvement with symptoms. PEI was not identified in palliative bypass or GIST surgery.

No significant improvement in weight was seen 9-12 months post-operatively in patients who began Creon 0-3 months after their operation, with a p-value of 0.19. Not enough grip strength data was available to analyse. The average final PERT dosage in patients that reported some improvement to improvement in symptoms was 50,000 – 75,000 units with every meal and snack. 

Conclusions

More prevalent usage of PERT seen in total gastrectomy resections with good effect. This finding would benefit from further higher quality research to determine the mechanism behind this to support wider PERT usage in this patient group. In view of the overall positive outcomes in regards to symptom control across gastrectomies and oesophagectomies, albeit in small numbers, it should be a considered treatment and regularly screened for. In order to get a statistically significant result in regards to weight improvement when commenced on PERT a bigger sample size would be needed
P-OGC20 Can prehabilitation prevent development of sarcopenia during neoadjuvant chemotherapy for oesophagogastric adenocarcinoma?
Authors: Chmelo Jakub , Navidi Maziar , Phillips Alexander W , Greystoke Alastair , Sinclair Rhona CF
Published: December 2021

Background

Sarcopenia characterised as a loss of muscle mass and function is prevalent in cancer populations. It is known to occur in patients receiving neoadjuvant treatment and is associated with poorer outcomes. Thus, minimizing sarcopenia may lead to improved patient prognosis. It has been suggested that exercise can reverse and prevent sarcopenia. Little is known as to whether prehabilitation as an intervention to enhance patients’ functional capacity prior to surgery can lead to sarcopenia prevention.

Methods

Patients enrolled into a prospective prehabilitation study (ChemoFit) during neoadjuvant chemotherapy (NAC) for oesophagogastric adenocarcinoma (OGA) had their radiological sarcopenia measured before and after neoadjuvant chemotherapy (NAC). Radiological sarcopenia and lean body mass (LBM) were measured from computed tomography scans at the level of the L3 vertebra. ChemoFit patients were compared with an historical cohort (NO-PREHAB) which did not undergo prehabilitation and which had their radiological sarcopenia evaluated prospectively prior to and after NAC for OGA.

Results

Patients in the ChemoFit group were younger compared to the NO-PREHAB group (median age 70 vs 65, p = 0.04). Otherwise there were no differences in gender, BMI, smoking status, comorbidities, tumour location and clinical stage of the disease. Radiological sarcopenia was present prior to NAC in 17/36 (47%) which increased to 26/36 (72%) after NAC amongst ChemoFit patients. Sarcopenia prior to NAC in the NO-PREHAB cohort was 12/28 (43%) which increased to 16/28 (57%) post NAC. Intergroup difference (p = 0.291). Median (IQR) ΔLBM at two time points was in ChemoFit -2.6kg (-5.2;-0.6) and in NO-PREHAB -3.1kg (-4.7;-1.0) (p = 0.730).

Conclusions

Radiological sarcopenia increased in both groups during NAC for OGA. Prehabilitation did not prevent this from happening. Other strategies must be explored in order to mitigate against sarcopenia.
P-OGC25 Prognostic significance of extracapsular lymph node involvement after gastrectomy for gastric adenocarcinoma
Authors: Prasad Pooja , Chmelo Jakub , Wahed Shajahan , Navidi Maziar , Phillips Alexander
Published: December 2021

Background

Lymph node involvement is a key prognostic indicator in gastric adenocarcinoma. Little is known of the impact of extracapsular lymph node involvement (LNI) upon the prognosis of patients undergoing curative resection of gastric cancer. The aim of this study was to assess the incidence and prognostic significance of extracapsular LNI in patients undergoing a gastrectomy for gastric adenocarcinoma. 

Methods

Consecutive patients who underwent a subtotal or total gastrectomy with curative intent for adenocarcinoma of the stomach or gastro-oesophageal junction in a single, high-volume U.K. centre between 2010 and 2018 were identified from contemporaneously maintained database. Patients with a pN0 status on final histology and those who died in-hospital were excluded from analysis. Factors associated with survival were studied with univariable and multivariable cox regression analysis. A p value of < 0.05 was deemed significant. 

Results

The study included 235 patients. A median (IQR) of 32 (24-43) lymph nodes were resected and median (IQR) 4 (1-9) lymph nodes were positive. Of them, extracapsular LNI was identified in 123 (52%) of patients. Factors associated with survival on univariable analysis were R1 resection (p = 0.001), p/ypT stage (p < 0.001), p/ypN stage (p < 0.001) and extracapsular LNI (p = 0.001). Median survival among patients who had extracapsular LNI was 19 months versus 49 months among patients who did not (p < 0.001).  Extracapsular LNI was not an independent predictor of survival on multivariable analysis (p = 0.535). 

Conclusions

Extracapsular LNI is associated with poor prognosis among patients undergoing a curative gastrectomy. However, it is not an independent predictor of survival among this patient population.
P-OGC50 An Objective Evaluation of Youtube Videos on Oesophageal Cancer using the PEMAT Score
Authors: Musbahi Aya , Immanuel Arul
Published: December 2021

Background

Studies in patient literature particularly regarding online video literature in all fields are few. Scoring systems for video materials such as the validated PEMAT(Patient Education Material Assessment Tool)  have been used before to look at video patient literature. The aim of this study is to use the PEMAT tool to evaluate the quality of Youtube patient literature on oesophageal cancer and look at the inter rater reliability between lay and medical scorers.

Methods

A Youtube search was performed in April 2021 using the search terms “oesophageal cancer”, “esophageal cancer” “gullet cancer”. Characteristic data collected included language, ratings (thumbs up), type of video, country of origin and presence of advertising as well as intended audience. A PEMAT tool which is validated instrument to rate patient video material was used. A score of 70% is acceptable in the actionability and understandability domains. Cohen’s kappa coefficient was used to test inter-rater reliability between two lay person raters; and two medical raters.

Results

Seven sites were rated as understandable by the medical raters average and 13 were rated understandable by the lay raters average. Only two videos achieved best case scenario where both medical raters rated as understandable, rather than the average of both. Twelve videos were rated by both lay raters as understandable. Actionability rated poorer with only two videos rated as actionable on average by the medical raters and seven rated actionable by the lay raters on average.

Conclusions

Youtube videos on Oesophageal cancer score poorly in terms of actionability and understandability.
P-OGC52 FLOT or CROSS for Neoadjuvant therapy for Esophageal Cancers: An International Cohort Study
Authors:   Oesophagogastric Anastomosis Audit Collaborative
Published: December 2021

Background

Ongoing debate exists between neoadjuvant FLOT or CROSS for oesophageal cancers, especially adenocarcinoma (EAC). However, current evidence is limited to institutional series with mixed inclusion of oesophageal squamous cell carcinoma (ESCC). Therefore, and large, multicenter studies are limited. This study aimed in reporting pathologic outcomes comparing FLOT and CROSS.  

Methods

Patients undergoing receiving neoadjuvant therapy (i.e. FLOT vs ECF/ECX vs. CROSS) curative resection for EAC were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. Primary outcome was pathologic complete response (pCR). Secondary outcomes include margin-negative resections, post-operative complications (i.e. anastomotic leaks, major complications) and 90-day mortality. Sensitivity analyses were performed in patients who had completed all cycles of planned neoadjuvant chemotherapy.

Results

This study included 1,030 patients with oesophageal cancers. In patients with EAC, 36% (n = 368) received FLOT, 30% (n = 312) received ECF/ECX and 34% (n = 450) received CROSS. Patients receiving CROSS had significantly higher rates of pCR (18% vs 10% vs 4%, p < 0.001) and margin-negative resections (93% vs 76% vs 69%, p < 0.001) than patients receiving FLOT or ECF/ECX, which remained in adjusted analysis. Patients receiving ECF/ECX had significantly higher rates of completion of all planned cycles than FLOT or CROSS (91% vs 87% vs 82%, p < 0.001). Sensitivity analyses of patients with who completed all planned cycles demonstrated CROSS had significantly higher rates of pCR (19% vs 11% vs 4%, p < 0.001) and margin-negative resections (92% vs 78% vs 70%, p < 0.001) than patients receiving FLOT or ECF/ECX.

Conclusions

CROSS appears to achieve higher pCR and margin-negative rates than FLOT in EAC with comparable post-operative outcome profiles. This study provides real-world data in the absence of randomised controlled trials comparing these chemotherapy regimens. Future research should focus on long-term outcomes of FLOT in these patients  and role of FLOT in ESCC patients.
P-OGC53 Dashboarding for real-time analysis of oesophagogastric outcomes data
Authors: Ash Stephen , Antonowicz Stefan , Matarangolo Antonio , Menon Nainika , Owen Richard , Gillies Richard , Sgromo Bruno , Marshall Robert , Maynard Nick
Published: December 2021

Background

The typical paradigm for surgical service evaluation is intermittent audit based on perceived clinical need and mandated requirements. A better model would be monitoring patient outcomes automatically in real-time, with up-to-date cumulative frequencies of key surgical performance indicators such as surgical quality and morbidity, as changes in performance could be detected and reacted to at an earlier stage. This study aimed to develop a dashboarding technology to support real-time visualisation of prospectively maintained oesophagogastric cancer surgery data.

Methods

CODA is a bespoke databank (implemented in MS SQL Server, with HTML, C# and JavaScript) for oesophagogastric cancer care at our centre. We built on a custom dashboard interface for displaying this information in real-time, using Shiny for R and Tableau. We identified the key performance indicators (KPIs) to monitor in the dashboard, and defined benchmarks based on accepted standards, or our prevailing performance (based on 448 consecutive patients who underwent oesophagectomy between 2015 – 2020). The domains selected were surgical quality, length of stay, early mortality, and priority complications. Complications were defined according to the Esophagectomy Complications Consensus Group.

Results

For surgical quality, our benchmarks based on prevailing performance were (i) >90% >15 lymph node yield (ii) <2-5% longitudinal R1 (iii) <20-30% CRM R1. For length of stay, our benchmarks were (i) >33% meeting 8 day discharge target (ii) <15% missing target discharge without a medical complication (iii) <20% staying longer than two weeks. For 30 & 90 day mortality, our benchmarks were 2% and 4% respectively. For complications, two sets were identified: (i) common complications (occurring at > 2 / year, monitored 2-yearly) (ii) impactful complications (>1 / year, >1 week median additional stay, monitored 5-yearly)

Conclusions

The CODA dashboard provides real-time appraisal of oesophagogastric cancer surgery practice, highlighting changes in performance and providing opportunity for early intervention. The platform can be used for personal, departmental or inter-institutional service evaluation. The KPIs will be extended to oesophagogastric cancer survival as the test set matures. The interface and wider benefits of CODA implementation are presented, together with the dissemination plan for use in other oesophagogastric centres.
P-OGC58 Preoperative Enteral Feeding in Patients with Oesophagogastric Cancer
Authors: White Cathy , Arumugusamy Mayilone , Robb William
Published: December 2021

Background

Patients with Oesophagogastric (OG) cancer undergoing multimodal treatment have a higher risk for progressive decline in their nutritional status. Our centre has seen increased numbers of patients using jejunostomy and gastrostomy tube feeding as an additional support during neoadjuvant chemotherapy and radiotherapy (nCRT).  This audit aimed to evaluate the processes surrounding and the impact of this intervention.

Methods

A retrospective review of 2019 medical records.  Patients with OG cancer for treatment with curative intent that underwent an elective feeding tube insertion for preoperative supplementary feeding were included.

Results

14 patients were admitted for elective feeding tube insertion in 2019. On admission N = 10 patients (71%) had clinically severe weight loss (defined as ≥ 10% in 6 months, or ≥ 7.5% in 3 months or ≥ 5% in 1 month).  Four (29%) had a dietetic assessment pre admission, with 1 patient (7%) trained on home enteral nutrition pre admission.

Conclusions

This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this.   For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.
P-OGC61 Long-term outcomes following minimally invasive oesophago-gastric resection for oesophageal and gastro-oesophageal junctional cancer: a single center experience
Authors: Orabi Amira , Chillarge Gauri , Di Mauro Davide , Veeramootoo Darmarajah , Mitchell keith , Reece-Smith Alex , Manzelli Antonio , Daneshmend Tawfique , Wajed Shahjehan
Published: December 2021

Background

Oesophago-gastric surgical resection for cancer has been associated with high morbidity and poor long-term prognosis. Medical advances have led to improvements and the con-current development of videoscopic technology enabled a paradigm shift in many areas of surgical practice. Between 2004 - 2010, a three-stage total (thoracoscopic/laparoscopic) minimally invasive oesophagectomy (MIO) with curative intent, was offered to all patients diagnosed and treated for esophageal and oesophago-gastric junctional (GOJ) cancers as an alternative to open surgery at our specialist Centre. Previously we have reported on safety, feasibility, short term outcomes, quality of life and complication profiles; this study now reports on eventualities at least a decade after surgery.

Methods

All patients who underwent MIO (laparoscopic/thoracoscopic) three-stage procedure from April 2004 to January 2010 for oesophageal and GOJ malignancy were identified. A retrospective analysis of patients’ records in conjunction with an updated clinical follow-up was carried out.  Patients’ demographics, oncologic stage (in accordance to the American Joint Committee on Cancer 6th and 7th Edition), overall survival, 5-year and 10-year survival, recurrence rate and disease-free survival (DFS) were retrospectively analyzed. Statistical analysis was conducted using Prism version 9.1.0 (GraphPad Holdings LLC, California).

Results

A total of 120 patients (majority of which were males – 84.2%) were included in the study. Mean age was 66.7 ± 0.74. 43 patients. In-hospital death occurred in 4 (3.3%) patients. Over the time period, 25 (20.8%) patients were alive. Of those deceased Sixty-six (69.5%) succumbed to cancer, and 29 (30.5%) died from other causes. 43 patients (35.8%) were alive at 5 years and 33 (27.5%) at 10 years. Excluding those with Stage 0 disease, the 5-year and 10-year survival rates were 32.4% and 24.1%, respectively. The recurrence rate was 63 (52.5%) patients and the overall median DFS was 24 months (IQR, 186); Stage 3 patients had the shortest DFS (p < 0.0001).

Conclusions

Survival and disease-free survival in this historical cohort of patients who underwent a total MIO for cancer is comparable to published data from similar open series of that era as well as modern reported outcomes from specialist centers. Benefits of a minimally invasive approach can therefore be realized without compromise to oncological and overall prognosis.
P-OGC62 Home Enteral Tube Feeding: The Patient’s Perspective. Are we delivering an effective dietetic service?
Authors: Forde Neasa , White Cathy
Published: December 2021

Background

Long term feeding tubes, managed independently at home have been shown to improve quality of life scores and in general are considered to be well tolerated. Beaumont Hospital has seen an increase in the number of patients referred for home enteral feeding (HEN) prior to neoadjuvant treatment for oesophagogastric (OG) cancer.   We aimed to gain an insight into the supports, experiences and challenges encountered by these patients in an emerging service.

Methods

A retrospective qualitative study using data from 2019-2020. A questionnaire was adapted from a multicentre Irish study in 2017. Patients with OG cancer for treatment with curative intent, that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Patients were provided with a questionnaire via post. Data was analysed using Microsoft Excel. 

Results

Response rate was 82% (14 of 17questionnaires).   Mean age 60.4yrs (SD 11.7).  93% male (N = 13).  In 36% (N = 5) tube feeding duration was < 3months and 3-6months duration in 43% (N = 6). 

Conclusions

Overall positive feedback was received from patients regarding living with a feeding tube, confirming the important and impactful role of HEN. Priorities for service improvements: improved discharge information and resources may help  reduce use of unreliable resources e.g. develop HEN discharge booklet to keep all relevant information in one accessible location, development of video education resources for consolidation of knowledge.  Aim to provide more structured follow up with clear plans and channels of communication outlined for the patient. Quality improvement work with surgical team to reduce complication rate with feeding tubes.
P-OGC71 Five positive lymph nodes are a significant negative indicator of survival in Oesophago-Gastric Cancer surgery: an 8-year study
Authors: Parker Tamsin , Riaz Amjid , Askari Alan , Ebrahim Ahmad , Tang Cheuk-Bong , Lorenzi Bruno , Jayanthi Naga Venkatesh
Published: December 2021

Background

Number of positive lymph nodes involved is an important prognostic indicator in Oesophago-Gastric cancer survival post surgery. We present an 8 year study examining the number of lymph nodes involved and its impacts on long term cancer survival and in particular to determine whether there is a threshold after which survival is significantly worsened.

Methods

A prospectively maintained single-institution database containing data from all patients from Jan 2012 to Dec 2020 was analysed. Survival analyses were undertaken to determine the association between lymph node positivity and survival. 

Results

A total of 430 patients underwent surgery for gastro-oesophageal cancer (oesophagectomy: n = 311, 72.3%; gastrectomy n = 119, 27.7%) of which 80.2% were male and the median age was 68 years old (IQR: 61-74). A median of 23 nodes were examined (IQR 18-33) and a median of one lymph node was positive for cancer (IQR 0-3 lymph nodes). The majority of patients (59.3%) had a T3 tumour, 24.0% had T2, and 12.1% had a T1 tumour. Over a median follow up of 30 months (IQR 13-61), 61.2% of the study population were alive. Kaplan Meier analyses demonstrated that patients who had five or more positive nodes had a survival of 36.3 months (IQR: 24.4-48.3 months) compared to those with four or fewer nodes (45.8 months, IQR: 27.6-64.1 months, p > 0.001). Survival did not worsen further with a higher number of positive nodes.

Conclusions

This study shows that having five or more positive lymph nodes significantly worsens Oesophago-gastric cancer survival. These results may suggest that from the threshold of 5 positive nodes, OG cancer behaves as a systemic disease and thus impact on adjuvant treatment strategies.
P-OGC75 Use of a single visit combined contrast enhanced CT with PET (PET/CeCT) in the staging of oesophageal and gastric cancers during the COVID-19 pandemic – is it adequate, timely and cost effective?
Authors: Jones Michael , Higgs Simon , Dwerryhouse Simon , Markos Vikas , Mason Karen , Lyburn Ian
Published: December 2021

Background

COVID-19 has had a massive effect on service provision within the NHS. At our regional oesophagogastric centre the usual protocol for workup of new cancers involves endoscopy, with separate imaging in the form of a contrast enhanced CT, and standard PET/CT (PET with non-contrast CT). To reduce exposure to the hospital environment and potential infection, a group of patients underwent combined PET/CeCT imaging in a single hospital visit. The aim of this project was to assess whether the combined scans were of adequate diagnostic quality, cost efficient, and if they reduced time to treatment.

Methods

We retrospectively identified all patients who had been discussed in the Upper GI cancer MDT in 2020 at our trust. To be included in the study, the diagnosis must have been made during 2020. Using our MDT records, clinical letters, endoscopy and radiology systems, we obtained dates of investigations along with types and dates of treatment. Data was tabulated in Microsoft Excel. Upper GI consultant radiologists advised on diagnostic quality and technicality of scans, and trust finance directors were able to advise on costs of imaging.

Results

211 new oesophageal or gastric cancers were discussed in our MDT in 2020. 33 patients had PET/CeCT, these took place between March and October. 178 patients had separate imaging. Median time from diagnostic OGD to PET/CeCT was 8 days vs 16 days to final imaging in the separate group. Median time from diagnostic OGD to treatment start date was 36 days for PET/CeCT vs 41 days in the separate group. No PET/CeCT’s required repeating due to poor diagnostic quality. At our trust PET/CeCT had a cost saving of £88.58 compared to separate scans.

Conclusions

Our experience is that PET/CeCT allows accurate radiological staging of oesophagogastric cancers with a single patient visit, at more convenience to the patient and with reduced potential exposure to COVID-19. Patients were able to complete their cancer staging and start their treatment pathway sooner than with separate scans. This comes with a significant cost saving to the NHS per patient, which at our trust scaled up to a potential £18,000 in one year. Our MDT is now planning to perform radiotherapy planning CT images in the same episode.
P-OGC77 Why curative treatment rates are so low for stage I/II Oesophago-gastric cancer in the West of Scotland? – A five year review
Authors: Khan Khurram , Gall Lewis , Miller Gillian , Macdonald Andrew , Craig Carol , MacKay Colin , Forshaw Matthew
Published: December 2021

Background

Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland.  QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed.  This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment. 

Methods

The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2015 and December 2019 to identify those patients who did not have curative treatment.  Electronic records were then analyzed and the reason for the non curative treatment recorded.

Results

260 patients (mean age 78.3 ± 9 years; 114 (43.8%) female) were identified. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-7).   There were 159 (61.2%) oesophageal cancers, 196 (75.4%) adenocarcinomas and 174 (66.9%) were Stage II cancers.  Formal CPEX fitness was assessed in only 20 patients (7.7%).  Reasons for curative treatment not being received were as follows: not clinically fit (n = 216 (83.1%)); patient declined curative treatment (n = 17 (6.5%)); disease progression (n = 16 (6.2%)) and identification of synchronous cancers (n = 9 (3.5%)).

Conclusions

Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent.  This may be related to the previously described “West of Scotland” effect on health comorbidities.
P-OGC80 The effect of COVID -19 on new diagnosis oesophagogastric cancer patients in the UK: A single-centre experience
Authors: McQuillan Patrick , Ahmed Salman , Navidi Maziar , Hayes Nick , Wahed Shajahan , Immanual Arul , Phillips Alex
Published: December 2021

Background

Covid-19 has had a devastating global impact and resulted in over 4.4 million directly attributed deaths. The UK entered lockdown in March 2020, redistributing its medical workforce and resources. Early estimations suggested at least 4700 extra cancer deaths at 5 years if there was a 3-month delay to surgery. Delays to diagnosis and treatment for osophagogastric (OG) cancers can be particularly detrimental to survival. 

The aim of this study is to assess the impact of Covid-19 on new cancer referrals to a centralised UK OG cancer centre, including presentation, decision making and treatment. 

Methods

Patients with OG cancer referred to a tertiary, high-volume centre between March 2019 and March 2021 were reviewed. Patients were stratified into Pre-covid (March 2019-March 2020) and Covid (March 2020-2021) cohorts. Number of new referrals, clinical stage, treatment decision, and time to treatment were compared for gastric adenocarcinoma (GA), oesophagogastric-junction adenocarcinoma (OGJA), oesophageal adenocarcinoma (OA) and oesophageal SCC (OSCC).

Results

There was an 11% reduction in new cancer referrals (485 vs 431). GA, OGJA and OA did not have significant change in treatment intent, although there was a significant increase in the decision for definitive non-surgical treatment of OA (P = 0.046). GA and OA patients had a small, but significant increase in mean clinical stage at presentation (P < 0.05). There was no increase in time to treatment for GA, OGJA and OA. A significantly higher proportion of OSCC patients were given curative intent treatment in the Covid-19 cohort (P = 0.0006) however, this was accompanied with an increased time to treatment commencement (35.8 days vs 27.9 days P = 0.0198).  

Conclusions

This high-volume centre has seen a reduction in new cancer referrals since the first UK lockdown. This was associated with a small, but significant, increase in clinical stage of GA and OA at presentation. This may represent an early indication of excess oesophagogastric cancer deaths due to the impact of Covid-19. This data also confirms initial results showing that oncological decisions were not compromised, although Covid-19 remains a dynamic challenge.
P-P06 Ward based goal directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: a feasibility randomised controlled trial [ISRCTN 36077283]
Authors: Froghi Farid , Soggiu Fiammetta , Ricciardi Federico , Vindrola-Padros Cecilia , Floros Lefteris , Martin Daniel , Filipe Helder , Varcada Massimo , Gurusamy Kurinchi , Bhattacharya Satyajit , Fanshawe Angela , Dolcea Bogdan , Mathur Pawan , Davidson Brian
Published: December 2021

Background

Goal directed fluid therapy (GDFT) based on cardiac output assessment has been shown to reduce complications and improve survival for people undergoing major general surgery. There are no reports of cardiac output evaluation being used to optimise the fluid administration for patients with acute pancreatitis who are in a general surgery admission ward.

Methods

The trial protocol has been published. 50 patients with acute pancreatitis were recruited, consented and randomly allocated to either ward-based GDFT with intravenous (IV) fluids administered based on stroke volume optimisation or standard ward care but with blinded cardiac output evaluation for 48 hours following hospital admission.

Results

Over a period of 20 months 50 of 142 screened patients were recruited demonstrating that it was feasible to recruit into a randomised trial of this nature in ward patients with acute pancreatitis. 36 (72%) completed the allocated 48 hours of goal directed fluids with 10 (20%) discharged within 48 hours and 4 withdrawals (3 GDFT and 1 SC).  Baseline characteristics of the groups were similar with only 3 participants having severe disease (6%, 1 GDFT, 2 SC). Similar volumes of IV fluids were administered in both groups (GDFT 5465 (1839) ml, SC 5211 (1745) ml). GDFT group had a lower heart rate, blood pressure and respiratory rate and improved oxygen saturations. GDFT was not associated with any harms. Complications of AP appear to be similar as was duration of stay in intensive care. Length of hospital stay was 5 (2.9) in GDFT and 6.3 (7.6) in SC groups.

Conclusions

Ward GDFT is feasible and shows a signal of possible efficacy in acute pancreatitis in this early-stage study. A larger multi-site RCT is required to confirm clinical and cost effectiveness.
P-P09 Salvage transgastric necrosectomy as a part of a step-up approach to managing acute necrotising pancreatitis
Authors: Ngan Franko Shing Fun , Sarkar Srishti , Arshad Ali , Maher Ben , Tehami Nadeem , Stevens Claire , Takhar Arjun
Published: December 2021

Background

The use of EUS (endoscopic ultrasound) guided drainage with endoscopic LAMS (lumen apposing metal stent) necrosectomy is an emerging treatment option for walled-off pancreatic necrosis (WOPN) secondary to acute severe pancreatitis. It can delay or remove the need for surgical necrosectomy, which can be associated with high morbidity and mortality. However, the endoscopic approach is not always successful due to a multitude of factors and salvage transgastric necrosectomy can be performed using the tract created by the LAMS to achieve internal drainage and remove necrotic pancreas. 

Methods

We describe our unit’s experience in managing WOPN in two patients. We suggest a treatment pathway of WOPN which includes a step-up approach including salvage transgastric necrosectomy in patients where multiple endoscopic necrosectomies and washouts have failed. 

Results

Two patients, aged 67 and 69, were admitted as intensive care transfers for gallstone and alcohol pancreatitis respectively. They underwent a step-up approach to treat their infected WOPN, starting with the deployment of LAMS and endoscopic necrosectomy. They both showed brief clinical improvement after repeated endoscopic necrosectomy but further imaging showed ongoing large collections that could not be treated endoscopically. Both patients underwent successful transgastric open necrosectomy where necrotic pancreatic tissue was accessed surgically through the already created cyst-gastrostomy. This had the advantage of internal drainage of the collection into the stomach without the need for external surgical drains.

Conclusions

The emphasis in the treatment of WOPN has shifted to minimally invasive percutaneous or endoscopic drainage modalities. Endoscopically inserted LAMS may not always achieve definitive drainage of the WOPN but should be employed in the first instance as they are associated with reduced morbidity and mortality compared to surgery. Ultimately, open necrosectomy with washout remains the definitive management strategy in the step-up approach. We believe that the trans-gastric open necrosectomy approach can be used successfully in patients where the minimally invasive approach has failed.
P-P34 Impact of an Enhanced Recovery After Surgery Protocol on Short-Term Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy
Authors: Raza Syed Soulat , Nutu Anisa , Powell-Brett Sarah , Boteon Amanda Carvalheiro , Hodson James , Abradelo Manuel , Dasari Bobby , Isaac John , Chatzizacharias Nikolaos , Marudanayagam Ravi , Mirza Darius , Roberts Keith , Sutcliffe Robert
Published: December 2021

Background

In an effort to improve postoperative recovery and reduce complications, enhanced recovery after surgery (ERAS) pathways have been  introduced across a range of surgical disciplines. The demographics of patients being considered for PD have evolved over recent decades, with older patients undergoing increasingly more complex procedures. The feasibility and benefits of an ERAS protocol for elderly patients undergoing PD is debated, a recent study suggesting that age over 70 years is an independent risk factor for protocol failure . Existing studies on ERAS after PD in elderly patients are limited by small sample sizes and failure to include a pre-ERAS control.

Methods

830 consecutive patients who underwent PD between January 2009 and March 2019 were divided according to age: elderly (≥75 years) vs. non-elderly patients (<75 years). Within each age group, cohort characteristics and outcomes were compared between patients treated pre- and post-ERAS (ERAS was systematically introduced in December 2012). Univariable and multivariable analysis were then performed, to assess whether ERAS was independently associated with length of hospital stay (LOS).

Results

Of the entire cohort, 577 of 830 patients (69.5%) were managed according to an ERAS protocol, and 170 patients (20.5%) were aged ≥ 75 years old. Patients treated post-ERAS were significantly more comorbid than those pre-ERAS, with a mean Charlson Comorbidity Index of 4.6 vs. 4.1 (p < 0.001) and 6.0 vs. 5.7 (p = 0.039) for the non-elderly and elderly subgroups, respectively. There were significantly fewer medical complications in non-elderly patients treated post-ERAS compared to pre-ERAS (12.4% vs. 22.4%; p = 0.002), but not in elderly patients (23.6% vs. 14.0%; p = 0.203). On multivariable analysis, ERAS was independently associated with reduced LOS in both elderly (14.8% reduction, 95% CI: 0.7-27.0%, p = 0.041) and non-elderly patients (15.6% reduction, 95%CI: 9.2-21.6%, p < 0.001), with the effect size being similar in each group.

Conclusions

ERAS protocol can be safely applied to patients undergoing pancreaticoduodenectomy irrespective of age. ERAS is associated with a significant reduction in postoperative LOS in elderly and non-elderly patients, despite higher comorbidity in the post-ERAS period.
P-P44 Clinical outcomes of consecutive patients undergoing distal pancreatectomy over the last decade at a high volume tertiary pancreatic surgery unit
Authors: Patel Bhavik , Fristedt Richard , Hamady Zaed , Takhar Arjun , Armstrong Tom , Hilal Mohammad Abu , Karavias Dimitrios , Arshad Ali
Published: December 2021

Background

Distal pancreatectomy (DP) enables resection of lesions in the body and tail of the pancreas.  Over the past decade, the Laparoscopic approach has become frequently employed.  There remains scarce outcome data available following laparoscopic distal pancreatectomy over a long time period from high volume centres. Postoperative pancreatic fistula (POPF) remains the main source of morbidity and mortality after DP. The causes of POPF are multifactorial and poorly understood.  The optimal method of pancreatic stump closure is still debated with variation in clinical practice.

Methods

All patients that underwent distal pancreatectomy at a UK tertiary pancreatic surgery centre between January 2011 and January 2021 were identified and clinical outcomes examined. Patients undergoing completion pancreatectomies were excluded. Clinical, pathological and surgical data for the included patients was retrospectively collected from the electronic patient record.  Clinically significant POPF was defined as Grade B or C as per the ISGPF guidelines. For stapled stump closure, the Compression Index (CI) was calculated using closed staple height (mm) divided by the pancreatic thickness (mm). High and low CI was defined around the median.

Results

233 patients (n = 90 open and n = 143 laparoscopic) were included in the final analysis. The laparoscopic approach was associated with comparable morbidity and significantly lower blood loss, shorter operative time and shorter length of stay. There were no significant differences in age, sex, final histology, closure technique, or ASA Score of 3 or more amongst patients with clinically relevant POPF (CR-POPF). The POPF group had a significantly higher BMI, drain duration and readmission rate. CI data was available for 78 cases (range 0.04-0.21). There was no significant difference in low vs high CI for patients with CR-POPF.

Conclusions

Laparoscopic distal pancreatectomy is associated with favourable clinical outcomes in this series. Stapled vs sutured closure of the pancreatic stump offered equivocal outcomes with relation to POPF. POPF continues to have a significant impact on a clinical recovery as evident from longer drain duration and high readmission rates. Further research is required to try to establish methods for reducing the incidence of POPF after distal pancreatectomy.
USP53 activated by H3K27 acetylation regulates cell viability, apoptosis and metabolism in esophageal carcinoma via the AMPK signaling pathway
Authors: Cheng Wei , Tang Yong , Tong Xiaobin , Zhou Qin , Xie Jingrong , Wang Jinlong , Han Yun , Ta Na , Ye Zhou
Published: December 2021

Esophageal carcinoma (ESCA) is a leading cause of cancer death worldwide, despite an overall decline in the incidence of new cases. However, knowledge of gene expression signatures for risk and prognosis stratification of ESCA is inadequate. Thus, identifying novel molecular biomarkers and therapeutic targets for ESCA might improve its prognosis and treatment. The current study investigated the role of ubiquitin-specific peptidase 53 (USP53), a member of the USP family that exhibits deubiquitinating activity, in ESCA and showed that USP53 is downregulated in ESCA tissues, indicating poor prognosis. USP53 suppresses the proliferation and growth of ESCA cells in vitro and in vivo, whereas its knockdown exerts opposite effects. AMP-activated protein kinase inhibitor reverses the effects of USP53 knockdown. USP53 also inhibits glycolysis, oxidative metabolism and mitochondrial dynamics. H3K27 acetylation increases USP53 expression by binding to its promoter region. Our study reveals that USP53 is activated by H3K27 acetylation and suppresses ESCA progression by regulating cell growth and metabolism. USP53 is therefore a promising target for ESCA treatment.
Task-specific employment of sensory signals underlies rapid task switching
Authors: Sasaki Ryo , Kumano Hironori , Mitani Akinori , Suda Yuki , Uka Takanori
Published: December 2021

Much of our flexible behavior is dependent on responding efficiently to relevant information while discarding irrelevant information. Little is known, however, about how neural pathways governing sensory-motor associations can rapidly switch to accomplish such flexibility. Here, we addressed this question by electrically microstimulating middle temporal (MT) neurons selective for both motion direction and binocular disparity in monkeys switching between direction and depth discrimination tasks. Surprisingly, we frequently found that the observed psychophysical bias precipitated by delivering microstimulation to neurons whose preferred direction and depth were related to opposite choices in the two tasks was substantially shifted toward a specific movement. Furthermore, these effects correlated with behavioral switching performance. Our findings suggest that the outputs of sensory signals are task specific and that irrelevant sensory-motor pathways are gated depending on task demand so as to accomplish rapid attentional switching.
Central volume shift in acute heart failure revealed by blood volume monitoring during haemodialysis
Authors: Sumi Hirofumi , Ishii Akari , Yamada Yuki , Shibagaki Yugo , Tominaga Naoto
Published: December 2021

Central volume shift is one of the major pathophysiological mechanisms of acute pulmonary oedema in acute heart failure (AHF). Pathological vasoconstriction results in central volume shift; however, its onset and course have been rarely detected or recorded in clinical practice. We report an exceptional case of AHF developing during haemodialysis, with marked blood pressure (BP) elevation and paradoxical repeated reduction in blood volume (BV) detected by real-time BV monitoring, accompanied by worsening dyspnoea. This inverse correlation of BV and BP during haemodialysis indicates that the theoretical central volume shift was captured in real-world AHF.
Long-term outcome of hemiarch replacement in a proximal aortic aneurysm repair: analysis of over 1000 patients
Authors: Pearsall Christian , Blitzer David , Zhao Yanling , Yamabe Tsuyoshi , Rajesh Kavya , Kim Ilya , Bethancourt Casidhe , Hu Diane , Bergsohn Josh , Kurlanksy Paul , George Isaac , Smith Craig , Takayama Hiroo
Published: December 2021

OBJECTIVES

The aim of this study was to investigate the impact of hemiarch replacement in patients undergoing an open repair of proximal thoracic aortic aneurysm without arch aneurysm.

METHODS

A retrospective review was performed on 1132 patients undergoing proximal aortic aneurysm repair at our Aortic Center between 2005 and 2019. Inclusion criteria were all patients undergoing root or ascending aortic aneurysm repair with or without hemiarch replacement. Exclusion criteria were age <18 years, aortic arch diameter ≥4.5 cm, type A aortic dissection, previous ascending aortic replacement, ruptured aneurysm and endocarditis. Propensity score matching in a 2:1 ratio (573 non-hemiarch: 288 hemiarch) on 19 baseline characteristics was performed. The median follow-up time was 46.8 months (range 0.1–170.4 months).

RESULTS

Hemiarch patients had significantly lower 10-year survival in the matched cohort (hemiarch 73.8%; 66.9–81.4%; vs non-hemiarch 86.5%; 81.1–92.3%; P < 0.001), driven by higher in-hospital mortality rate (4% vs 1%; P < 0.001). Cumulative incidence of aortic arch reintervention rates at 10 years was similarly low (hemiarch 1.0%; 0–2.5% vs non-hemiarch 1.3%; 0–2.6%, P = 0.615). Multivariate analysis with hazard ratios of the overall cohort showed hemiarch as an independent factor associated with long-term mortality (2.16; 1.42–3.27; P < 0.001) but not with aortic arch reintervention (0.76; 0.14–4.07, P = 0.750).

CONCLUSIONS

Hemiarch repair may be associated with higher short-term mortality compared to non-hemiarch. Arch reintervention was rare after a repair of proximal thoracic aortic aneurysm without arch aneurysm. Our data call for larger and prospective studies to further delineate the utility of hemiarch repair in proximal aortic surgery.
Impact of the first wave of the COVID-19 pandemic on cancer registration and cancer care: a European survey
Authors: Neamţiu Luciana , Martos Carmen , Giusti Francesco , Negrão Carvalho Raquel , Randi Giorgia , Dimitrova Nadya , Flego Manuela , Dyba Tadeusz , Bettio Manola , Gavin Anna , Visser Otto ,   the ENCR Steering Committee, Gavin Anna , Visser Otto , Sánchez María José , Eden Michael , Stracci Fabrizio , Šekerija Mario , Trojanowski Maciej , Bray Freddie , van Eycken Elizabeth , Miranda Ana , Storm Hans
Published: December 2021

Background

The coronavirus disease COVID-19 pandemic posed a number of challenges to the oncology community, particularly the diagnosis and care of cancer patients while ensuring safety from the virus for both patients and professionals: minimization of visits to the hospital, cancellation of the screening programmes and the difficulties in the management and operation of cancer registries (CRs) while working remotely. This article describes the effects in the medium term of the first wave of the COVID-19 pandemic on cancer registration in Europe, focusing on changes in cancer detection and treatment, possible reduction of CR resources and difficulties in the access to data sources.

Methods

A questionnaire was distributed in June 2020 to the directors of 108 CRs from 34 countries affiliated to the European Network of Cancer Registries, providing a 37% response rate.

Results

The results of the survey showed that cancer-screening programmes were mostly stopped or slowed down in the majority of regions covered by the respondent CRs. Cancer diagnostics and treatments were severely disrupted. The cancer registration process was also disrupted, due to changes in the work modalities for the personnel, as well as to the difficulties in accessing sources and/or receiving the notifications. In some CRs, staff was allocated to different activities related to controlling the pandemic. Several CRs reported that they were investigating the impact of COVID-19 on cancer care via dedicated studies.

Conclusions

A careful analysis will be necessary for proper interpretation of temporal and geographical variations of the 2020 cancer burden indicators.