bluuebunny/crossref_metadata_2025 huggingface dataset:
P-EGS06 Evaluating the impact of COVID-19 on the trend of emergency laparoscopic cholecystectomy
Authors: Agrawal Simrita , Sellahewa Chaminda
Published: December 2021

Background

Since the spread of the new SARS-CoV2 coronavirus in March 2020 to the UK, contradictory recommendations on the practice of laparoscopic cholecystectomies fuelled some debates among surgeons. The British Intercollegiate General Surgery Guidance recommended laparoscopic cholecystectomy as the treatment of choice for acute cholecystitis during the COVID-19 pandemic. Contradictorily, the Royal College of Surgeons of England warned about the unknown risk of viral infection and the release of pressurised gas from laparoscopic surgery. The audit aimed to identify the differences in surgical care before and during the pandemic to study their impact on patients.

Methods

Retrospective patient data was obtained from September 2019 to September 2020 to include data six months before the pandemic and six months during the pandemic. The data obtained had the patient hospital number, fitness for cholecystectomy, decision made regarding surgery, date of admission and date of surgery.

Results

178 patients before COVID-19 and 242 patients during COVID-19 were admitted with gallstone disease. Before COVID-19, 60.67% (n = 108) patients were fit and consenting for surgery. Of these patients, 60.19% (n = 65) were discharged for surgery later and 39.81% (n = 43) had inpatient emergency surgery. During COVID-19, 71.49% (n = 173) patients were fit and consenting for surgery. However, 87.86% (n = 152) were discharged for surgery and only 12.14% (n = 21) had inpatient surgery. The average time from admission to surgery increased from 8 days to 51 days during COVID-19. Although majority of inpatient surgeries were performed within eight days, the percentage performed was fewer during COVID-19.

Conclusions

The COVID-19 pandemic significantly affected emergency laparoscopic cholecystectomies performed in the hospital with a substantial increase in the average time taken from admission to surgery. More emergency laparoscopic cholecystectomies should be included in the weekly elective lists, design for dedicated emergency cholecystectomy lists and increase utilisation of the CEPOD theatres along with staff availability are required to achieve the emergency cholecystectomy service as guided by the Royal Colleges.
P-EGS12 An observational study investigating the differences the COVID-19 Pandemic had on admissions, methods of injury in a tertiary trauma centre in a major UK City
Authors: Mwangi Brian , Smith Stella
Published: December 2021

Background

During March 2020 the country was plunged into a nationwide lockdown. Despite this, there remained a steady stream of trauma admissions. COVID changed a lot about how many medical specialties worked and we wanted to explore the effects on our patient population, and compare it to the experience of other hospitals.  

Methods

We analysed existing data on admissions to the Emergency Department that were referred to the trauma service between the 12th of March to the 24th of May; encompassing the lockdown and the two weeks either side. This data was compared to that of the year beforehand. We compared ages, sexes, mortality, methods of injury, and disposition.

Results

Admissions fell, 193, compared to 271 (∼3:1 M:F). Both cohorts featured more younger people, but there was a drop-off in the number of older folk post-COVID; 6 of 9 centiles of the over 60s showed a fall in admissions of at least 14%. Those admitted to the Major Trauma service (ISS 9+) remained the same. Regarding the methods of injury,  the most common presentations remained road traffic accidents, stabbings and falls <1m, contributing to 71 and 72%  total admissions before and after COVID respectively. However, there were fewer patients falling from heights of > 2m (OR 0.5), and fewer recorded assaults (OR 4.0). Penetrating injuries were separated into “stabbings” and “others”. There was a significant increase in non-stabbing penetrating injuries (OR 4.6), a majority of which were self-inflicted. The rate of self harm during the lockdown showed a similar increase, from featuring in 8% of total presentations to 15% of admissions (OR 1.87).  The hospital restructured considerably between the sample dates such that dispositions are not possible to compare meaningfully. Rates of patients sent straight home from the ED were similar (OR 1.0).

Conclusions

Overall, the lockdown had a moderate impact on patient numbers and demography. The data implies that the measures did small amounts to deter people from the roads and from interacting with each other in assaults and stabbings. Older people were less likely to present traumatically. The isolation may have led to a masking of mental health issues leading to a significant increase in self harm, which may present opportunities for restructuring of services in any the event of further major lockdowns. 

These conclusions are limited by the data, and next steps would include gathering more detailed mortality data.
P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka
Authors: Yunus Mohammad Alif , Hassan Najihah Farhana , Haris Ahmad Amirul Hafiz , Samad Abdul Rahim , Razali Faris Suhaimi , Ismail Yahya
Published: December 2021

Background

Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition.

Methods

Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka.

Results

From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (<10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine.

Conclusions

It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.
P-EGS22 Emergency cholecystectomy: A comparative study of patient outcomes during COVID-19 pandemic with pre-COVID-19 period
Authors: Kuan Jen , Rajendran Ilayaraja , Turner Paul , Ball Christopher , Date Ravindra , Krishnamohan Nitya , Ward Jeremy , Pursnani Kishore , Shetty Vinutha Daya
Published: December 2021

Background

Emergency cholecystectomy is recommended for all acute admissions with symptomatic gall stones. The Royal College of Surgeons and AUGIS on 25th March 2020 recommended that all laparoscopic procedures should be avoided during the COVID-19 pandemic with the view to minimise the risk of virus transmission from aerosol-generating procedures. This retrospective study compares the outcomes of patients undergoing emergency cholecystectomy during the COVID-19 period with the pre-COVID-19 period.

Methods

All patients who underwent emergency cholecystectomy (EC) from March 2019 to March 2021 were included. ‘Pre-COVID-19’ period was defined as 25th March 2019 to 24th March 2020, whereas the ‘COVID-19’ period was from 25th March 2020 to 24th March 2021. Mortality was considered as the primary outcome. Secondary outcomes include the 30-day postoperative complications based on the Calvien-Dindo classification (CDC) and the length of stay (LOS). Mortality and postoperative complications were assessed using the Chi-squared test, whilst LOS was studied using the Mann-Whitney U test. A p-value of < 0.05 was considered statistically significant.

Results

A total of 143patients underwent EC during the 24-month study period (75patients pre-COVID-19 and 68patients during COVID-19). The 30-day mortality was nil. 9patients;12% in pre-COVID-19 period and 11patients;16% in COVID-19 period underwent conversion to open cholecystectomy (p = 0.47). 18patients;24% from pre-COVID-19 and 19patients;27.9% from COVID-19 periods developed postoperative complications (p = 0.59). Grade-2-CDC complications were seen in 12patients;17.6% during COVID-19 period and 5patients;6.7% in pre-COVID-19 period (p = 0.0043). However, grade-3,4 CDC complications requiring intervention (p = 0.39), and ICU-admission (p = 0.62) were comparable in both periods. 1patient developed COVID-19 infection but made a full recovery. Mean LOS was 6-days in both periods, with no statistical difference (p = 0.28).

Conclusions

This study demonstrated no significant difference in patient outcomes who underwent emergency cholecystectomy during the COVID-19 pandemic compared to the pre-COVID-19 period. Emergency cholecystectomy should be offered to all surgically fit patients with symptomatic gall stones.
P-EGS24 Surgical case series of incarcerated diaphragmatic hernias following oesophagectomy for oesophageal cancer. Single centre experience
Authors: Raslan Charef , Alasmar Mohamed , Chaparala Ram
Published: December 2021

Background

Incarcerated post-oesophagectomy diaphragmatic hernia (IPODH) is a recognised surgical emergency and potentially hazardous event. Information regarding the natural course for this emergency and guidelines regarding the management were not described clearly in literature. This case series aim to review patients who presented as emergency with IPODH

Methods

This observation study is conducted at Salford Royal Hospital that has one of the largest oesophago-gastric unit in United Kingdom.  A 7-year period (April 2013 - April 2020) retrospective data collection is performed using prospectively maintained database. We reviewed the presentation and management course for all patients who presented as emergency with IPODH. 

Results

We identified 341 patients who underwent oesophagectomies over the seven-year period. Seven patients (2%) developed IPODH which required emergency surgery. All these patients underwent 2 stage oesophagectomies. Out of these, 5 patients had laparoscopic assisted procedure (hybrid), 1 patient had minimally invasive procedure and another patient had open operation. Mean time interval from esophagectomy to the acute incarcerated hernia presentation was 23 months. Only 1 patient developed acute diaphragmatic hernia on day 4 post-oesophagectomy.  

The incarcerated hernia contents were reported as small bowels (4 patients), gastric conduit (2 patients) and colon (1 patient). Dealing with these acute emergency cases can be difficult as the hernia contents are threatened. Therefore, most of these patients underwent emergency laparotomy, only 1 patient had laparoscopic procedure to repair the incarcerated hernia. Collagen mesh used to repair the defect only in 2 patients, whereas the rest of the patients had the defect repaired with primary sutures only. 

Conclusions

Minimally invasive techniques were associated with a higher incidence of post-oesophagectomy diaphragmatic hernia compared with open techniques. These hernias can lead to a significant and serious risk when they present with incarceration. The risk of the acute manifestation and significant post-repair morbidity support long-term surveillance for post-oesophagectomy diaphragmatic hernia and elective surgical treatment. Laparoscopic repair of non-complicated diaphragmatic hernia is feasible and effective in high-volume centres.
P-EGS29 Is an ambulatory emergency general surgery management pathway of biliary disease more cost effective than a traditional approach? A matched case series study
Authors: Standing Harriet , Boag Katie , Hughes Michael , Amtul Nasira
Published: December 2021

Background

Patients presenting with biliary colic with or without deranged liver function tests (LFT’s) requiring surgery have traditionally been managed as inpatients or on an elective basis. Emergency surgery has previously been associated with higher costs in comparison to outpatient, elective management.  

Methods

Thirteen patients presenting as an emergency with a diagnosis of cholecystitis, with or without deranged LFTs, who underwent different patient pathways resulting in laparoscopic cholecystectomy were identified randomly over 1 month period. They were then matched into groups to compare elective, inpatient and ambulatory care pathway management for patients with similar demographics and clinical picture. The costs of each patient’s journey, from acute presentation to discharge following laparoscopic cholecystectomy was calculated in conjunction with the patient level information costing team (PLICS).

Results

Three matched groups of patients were identified: 50-60M, 65-75F with normal LFTs, 60F with obstructive LFT’s. Each patient underwent an ultrasound scan of the upper abdomen, laparoscopic cholecystectomy with additional investigations dependent on the group and clinical picture. In each group, when elective, emergency inpatient or ambulatory care pathways were compared there was a consistent cost difference. The order from most expensive to cheapest was: inpatient management, elective management, ambulatory care. 

The difference in costs was primarily linked with emergency department assessment and inpatient bed stays with cost saving of up to £5000 in one group when comparing inpatient stay to ambulatory emergency care management.

Conclusions

The use of an ambulatory emergency general surgical pathway for patients with a variety of biliary colic presentations including those with deranged LFT’s is economically comparable and potentially advantageous to more traditional and established patient management pathway options in a number of patient demographics across age, gender and pathology. An ambulatory care pathway, when developed and used correctly can provide significant cost savings to a wide range of patients.
P-L11 Comparison of clinical efficacy between LAPS and ALPPS in the Treatment of Hepatitis B Virus-related Hepatocellular Carcinoma
Authors: Chen Zebin , Xie Wenxuan , Tang Mimi , Liao Junbin , Feng Shiting , Shen Shunli , Kuang Ming
Published: December 2021

Background

The aim of the study is to compare the safety and efficacy of modified ALPPS (laparoscopic microwave ablation and portal vein ligation for staged hepatectomy, LAPS) and classical associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

Methods

Clinical data of patients with HBV-related HCC who underwent LAPS or ALPPS surgery in our institute from April 2013 to October 2020 were retrospectively analyzed.

Results

31 patients with HBV-related HCC were retrospectively collected in this study (LAPS = 8, ALPPS = 23). 7 patients with LAPS and 19 patients with ALPPS proceeded to resection (resection rate: 87.5% vs. 82.6%, P > 0.05). The hypertrophy rate of future liver remnant (FLR) caused by ALPPS was higher than that of LAPS (24.3 vs. 11.7 mL/d, P = 0.024). Compared with the ALPPS, LAPS was associated with less blood loss (300ml vs. 40ml, P < 0.001) during stage 1, lower comprehensive complication index (CCI) after stage 1 (8.7 vs. 0, P = 0.023) and lower total CCI (20.9 vs 0, P = 0.018) for two stages. Two years’ recurrence-free survival rate and over survival rate for ALPPS and LAPS were 17.3%, 34.3% (P = 0.105), and 28.9%, 100.0% (P = 0.011) respectively.

Conclusions

Compared with ALPPS, LAPS can reduce the occurrence of complications in patients with HBV-related HCC and improve patients’ prognoses.
P-O12 Atraumatic Splenic Rupture Secondary to Concurrent Cytomegalovirus and Epstein Barr Virus Infection
Authors: McCollum Catherine , Khan Khurram , Sahni Dhruv , Bell David , Chong David
Published: December 2021

Background

Infectious Mononucleosis (IM) is a common viral illness among adolescents and young adults. While most cases are self-limiting, a small number of patient can develop life threatening complications, such as atraumatic splenic rupture (ASR). This is a rare but serious sequelae, and the commonest cause of associated mortality. While Epstein Barr Virus is commonly associated with IM, concurrent infection of cytomegalovirus (CMV) and EBV is rarely reported.  Both infections are associated with splenomegaly, however this is usually mild and very rarely results in ASR.

Methods

We present the case of an immunocompetent nineteen year old male who underwent emergency splenectomy for ASR secondary to concurrent EBV and CMV infection. He presented to the Emergency Department with a five hour history of severe, sudden onset left upper quadrant pain preceded by coughing fit. He reported a one year history of incidental splenomegaly and recent positive monospot test in community. Computerised tomography (CT) of abdomen and pelvis confirmed splenic rupture with large haemo-peritoneum and large sub-capsular haematoma. He was haemodynamically unstable and underwent laparotomy and splenectomy.

Results

Intraoperative findings included two litres of intraperitoneal blood and large spleen with sub-capsular haematoma; approximately seventeen centimetre diameter and weighed nine hundred and seventy grams. Pathology showed features of non-specific lymphoid hyperplasia. Serum virology confirmed high levels of CMV on polymerase chain reaction with low levels of EBV detected. Virology screening was incidentally repeated post discharge and at this time was consistent acute EBV infection. No alternative cause for splenic rupture or pre-existing splenomegaly has been identified.

Conclusions

The serology results in this case confirm acute CMV infection with most likely concurrent EBV infection. While we cannot confidently identify which virus caused splenic rupture in this case, ASR is a life threatening condition and an important differential in patients presenting with sudden onset LUQ pain and shock. Splenectomy remains the treatment of choice in haemodynamically unstable patients.
P-OGC04 Evaluation of post-operative surveillance strategies for oesophago-gastric cancers in the United Kingdom
Authors: Chidambaram Swathikan , Sounderajah Viknesh , Maynard Nick , Underwood Tim , Markar Sheraz
Published: December 2021

Background

Oesophago-gastric malignancies are associated with a high recurrence rate, yet there is a lack of  evidence to inform guidelines for the standardisation and structure of post-operative surveillance after curatively intended treatment. This study aimed to capture the variation in post-operative surveillance strategies across the United Kingdom and Ireland, and enquire the opinions and beliefs around surveillance from practicing clinicians. 

Methods

A web based survey consisting of forty questions was sent to surgeons or allied health professionals performing or involved in surgical care for oesophago-gastric cancers at high volume centers in the United Kingdom (UK). Respondents from each centre completed the survey on what best represented their centre. The first section of the survey evaluated the timing and components of follow-ups, and their variation between centres. The second section evaluated respondents perspective on how surveillance can be structured. 

Results

Thirty five surgeons from 25 centers consisting 28 consultants, 6 senior trainees and 1 specialist nurse had completed the questionnaire. 45.7% of responders arranged clinical follow-up at 2-4 weeks. Twenty responders had a specific post-operative surveillance protocol for their patients. Of these, 31.4% had a standardised protocol for all patients, while 25.7% tailored it to patient needs. Patient preference, comorbidities and chance of recurrence were considered as major factors for necessitating more intense surveillance than currently practised. 

Conclusions

There is a significant variation in how patients are monitored after surgery between centers in the UK. Randomised controlled trials are necessary to link surveillance strategies to both survival outcomes and quality of life of patients and to evaluate the prognostic value of different post-operative surveillance strategies.
P-OGC05 The introduction of an Upper Gastrointestinal (UGI) specific menu can reduce the need for routine jejunostomy (JEJ) placement following UGI Cancer resection
Authors: Dossou Vida
Published: December 2021

Background

Despite the fact that early oral feeding (EOF) after the surgical resection of oesophageal and gastric tumours is safe, and is associated with favourable early in-hospital outcomes, sooner return to physiological GI function and hospital discharge, there can still be some reluctance in establishing EOF. Concerns remain around risk of anastomotic leak, pneumonia, Naso-gastric tube (NGT) reinsertion, re-operation, readmissions and mortality. However, when utilising EOF, a reduction in length of stay, earlier removal of NGT and earlier initiation of soft diet can be observed. JEJ placement is beneficial however  complications can arise and the optimal nutritional pathway remains debatable. 

Methods

Patient satisfaction surveys were conducted amongst UGI Cancer patients following Cancer resection and analysed pre and post UGI menu development and staff training. Expert UGI Patient volunteers assisted in the UGI menu development through food tastings producing a new menu in collaboration with the catering department. The new menu was launched and an UGI snack box provided to the UGI Enhanced Recovery Unit (ERAS). 

Oral intake of Diet and Oral Nutritional Support was analysed for calorie and protein content post menu change, ward staff training and specialist UGI dietetic counselling. This was then compared with calculated minimum estimated nutritional requirements. 

Results

Of the ten patients audited pre discharge:

Remaining 1 patient achieved 51% of protein requirements, below the aim of 60%.

No patient audited required supplementary Enteral feeding via JEJ or Naso-jejunal tube

Patient satisfaction surveys were completed prior to catering staff training and menu revision, after the new menu was implemented. The results show a significant improvement in patient satisfaction following UGI menu implementation.

Conclusions

Specialist UGI RD support, UGI specific menu and Oral Nutritional Support can reduce the need for routine JEJ placement in favour of on an individual patient basis. 

Collaborative working between UGI Dietitians, Ward staff, Catering staff and Expert patients is required for UGI specific menu development to be effectual. 

This audit is limited to small numbers due to adapted operational procedures during the pandemic. This audit will be repeated on a larger scale to yield more meaningful data.  

Future audit will capture data on how many UGI patients went on to require enteral nutritional support with three months of discharge.
P-OGC11 Vitamin B12 supplementation post gastrectomy. A service audit in St. James’s hospital, Dublin
Authors: Temperley Hugo , Murray Cian , Carey James , Bolger Jarlath , Ravi Narayanasamy , Reynolds John V , Donohoe Claire
Published: December 2021

Background

Vitamin B12 deficiency is a well described complication post gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia and possible long term neurological symptoms. Treatment can be with standardised replacement regimens or to monitor B12 levels and replace as required.  This study assesses patient understanding of and compliance with B12 supplementation guidelines post total and subtotal gastrectomy. 

Methods

125 patients who underwent gastrectomy between 2010-2020 were available for study (86 total gastrectomies, 39 subtotal gastrectomies).  Patient data was collected by review of the hospital electronic records and individual phone calls. Patients were asked standardised questions to elicit knowledge of the importance of B12 supplementation and compliance with supplementation.

Results

92% (79/86) of total gastrectomy patients reported compliance in regular parenteral B12 supplementation.  Compliance was significantly lower for subtotal gastrectomies  for checking and/or replacing their vitamin B12 at 53.8% (21/39) (p < 0.001). 62.6% of patients stated that they knew it was important to supplement B12 post gastrectomy.  37.8% of participants could explain why this was important and 14.8% had any knowledge of the complications of vitamin B12 deficiency. Patients who were compliant with B12 supplementation had an improved understanding of why supplementation was important compared to those who did not.

Conclusions

Regular monitoring and supplementation of vitamin B12 levels is important post gastrectomy.  This study demonstrates good compliance in those undergoing total gastrectomy.  Patient understanding correlates with compliance, suggesting that patient education and knowledge reinforcement may be key to compliance with vitamin B12 supplementation.
P-OGC14 Global Level of Harm Upper Gastrointestinal (GLEOHUG) – a multinational gastric cancer cross- sectional appraisal
Authors: Herrera-Kok John , Bangash A H , Abouelazayem M , Galanis M , Yang W , Cheruvu C , Parmer C , Maggio F Di , Demirli Atici S , Isik A , Bandopyadaya S , Mahavar K , Viswanath Yirupaiahgari
Published: December 2021

Background

Gastric cancer (GC) is the 5th most common malignancy and remains one of the major causes of worldwide cancer-related deaths. COVID-19 pandemic has had a significant impact on the provision of cancer care. This study aims to overview the global standpoint of gastric cancer patients (GCP) during the first year of the pandemic.

Methods

The Upper Gastrointestinal Surgeons (TUGS), within its Global Level of Harm Project, designed an online cross-sectional survey to assess how gastric cancer patient’s management changed during the first year of the pandemic. The questionnaire included 33 questions about expertise, kind of health system, hospital organization and screening policies, personal protective equipment (PPE), change in patient’s characteristics, preoperative, operative and postoperative management of GCP.

Results

There were 209 participants from 178 centres & 50 countries). Results showed: most hospitals (88,18%) had restricted areas for COVID-19 patients; 53.58% of surgeons were redeployed; most frequent COVID-19 screening method was PCR (78,82%) & chest CT-scan (25,62%), and 55.98% lack full PPE. Preoperative management: 43.16% noted reduction in multidisciplinary teams (MDT) meetings; 28,42% increase in cT2 or higher GCP; 34,74% increase in metastatic (M1) GCP; 26,84% increase in patients receiving definitive palliative treatment; 23,68% note increase in frail patients; 50% increase in waiting list time; and 41,58% faced problems in the provision of oncological treatment. Operative management: 54,50% decrease in elective gastrectomies; 29,10% increase in urgent/semi-urgent gastrectomies; 37,04% decrease in the number of minimally-invasive gastrectomies (MIG); & 18,52% increase in the number of palliative surgeries. Postoperative management: 16,48% increase in the overall complication rate (OCR); 12,64% increase in the number of Clavien-Dindo 3 or higher complications; 8,13% increase in the leak rate; increase in pulmonary infections (26,79%) and bowel obstruction (2,39%); 44,51% note postoperative COVID-19; 15,38% increase in 30-days mortality; 23,08% mortality due to COVID-19 infection; 17,58% increase in the need for adjuvant treatment. Most patients were postoperatively assessed either through a face-to-face consultation or a hybrid approach.

Conclusions

COVID-19 pandemic has affected gastric cancer management by decreased frequency of MDT’s, higher clinical-stage migration and fuelled frailty. The pandemic increased waiting list time, the number of urgent and palliative surgeries, OCR, Clavie-Dindo 3 or higher complications, leak rate, and pulmonary infections. There was a noticeable high rate of postoperative COVID-19 infection and associated mortality. Further multicentric studies are warranted to affirm these findings.
P-OGC17 Feasibility and impact of a home-based prehabilitation programme on patients receiving neoadjuvant treatment for oesophagogastric cancer (the chemofit study)
Authors: Chmelo Jakub , Phillips Alexander W , Greystoke Alastair , Charman Sarah J , Avery Leah , Hallsworth Kate , Welford Jenny , Sinclair Rhona C F
Published: December 2021

Background

Treatment for locally advanced oesophagogastric adenocarcinoma (OGA) involves neoadjuvant chemotherapy (NAC) which has a negative impact on patient fitness. Using ‘prehabilitation’ to increase activity levels and fitness may affect physiology, postoperative outcomes and improve patient wellbeing and quality of life. The aim of this study was to evaluate feasibility, acceptability and the impact of a home-based structured prehabilitation programme in OGA.

Methods

This feasibility study recruited consecutive patients to a pragmatic home-based prehabilitation during NAC. Participants completed daily walking sessions to a targeted step-count and daily strengthening exercises, under the weekly supervision of the research team. The primary outcomes assessed feasibility through recruitment rate, completion rate and individual compliance with each component of the intervention. Secondary outcomes included fitness derived from cardiopulmonary exercise testing (CPET).

Results

A total of 42/58(72%) patients approached were recruited, 36/39(92%) patients completed the programme. Median compliance with wearing a pedometer and recording step count was 97.8%(IQR 93.2-100%) and median engagement with telephone contacts was 100%(IQR 93.1-100%). Median compliance with 30-minutes aerobic exercise was 70.2%(IQR 53.1-88.9%) and for strength exercises 69.4%(IQR 52.1-84.3%). Nineteen patients had pre and post intervention CPET with no significant difference in anaerobic threshold (mean difference -0.5 ml.kg-1.min-1, 95% CI -1.6 to + 0.6, p = 0.387) or VO2peak (mean difference -0.1 ml.kg-1.min-1, 95% CI -1.6 to + 1.4, p = 0.883).

Conclusions

This study shows that ChemoFit is feasible, safe and achieved excellent patient compliance and engagement. Future utilisation of this home-based prehabilitation programme may improve preoperative fitness during NAC and impact post-operative outcomes.
P-OGC29 Pathological response profiles of FLOT and ECX neoadjuvant chemotherapy in oesophageal adenocarcinoma
Authors: Knight William , Pepas Arion , Lee Melody , Hlukha Larysa , Jackson Andrew , Hossain Tanvir , Theophilidou Elena , Yanni Fady , Vohra Ravi , Parsons Simon
Published: December 2021

Background

70% of patients undergoing neo-adjuvant ECX chemotherapy for adenocarcinoma of the oesophagus, show little to know response in their primary tumour (Mandard 4,5). However, among these patients, those who have a complete nodal response (cN+ to ypN0) have equivalent survival to those with Mandard 1,2,3 tumours. FLOT chemotherapy has shown a survival advantage to ECX, however, rates of primary tumour response and nodal response are yet to be the focus of published study.

Methods

Retrospective cohort study comparing patients undergoing ECX and FLOT neoadjuvant chemotherapy between 2014 and 2021. Pathological outcomes were examined including, Mandard tumour regression grade (1-5), complete nodal response (cN+ to ypN0), clinically node negative nodal progression (cN0 to ypN+).  

Results

226 patients had data available for analysis (193 ECX and 33 FLOT). 27% (52/193) of patients receiving ECX showed a response in the primary tumour (Mandard 1,2,3) compared to 63% (21/33) with patients undergoing FLOT (p < 0.001). Complete nodal response rates were 25% in ECX patients and 21% FLOT patients (p = 0.556). Clinically node negative nodal upstaging (cN0 to pN+) was higher among FLOT patients 30% (13/33) than ECX patients 12% (24/193) (p < 0.001).

Conclusions

FLOT chemotherapy confers improved primary tumour response. However, these findings were not echoed in locoregional nodal responses. Survival advantages with FLOT may result from improved responses in primary tumour and not improved systemic coverage. More data will be needed to explore this and over-come the confounding effect of staging inaccuracies. However, understanding systemic and loco-regional responses of different chemotherapy regimens will be needed to tailor future neoadjuvant treatment regimens.
P-OGC32 Copper-dependent cell death is a cancer specific vulnerability in oesophageal adenocarcinoma and provides the opportunity for future biomarker-stratified clinical trials
Authors: Hughes Rebecca E , Elliott Richard JR , Munro Alison , Hupp Ted , Carragher Neil O , O'Neill J Robert
Published: December 2021

Background

Oesophageal adenocarcinoma (OAC) is of increasing global concern due to increasing incidence, lack of effective treatments, and poor prognosis. Therapeutic target discovery and clinical trials have been hindered by the heterogeneity of the disease, dominance of large-scale genomic rearrangements, and lack of driver mutations. We have profiled small-molecule compounds using an innovative high content imaging assay in a panel of transformed and non-transformed oesophageal cell lines to identify OAC-specific cytotoxic compounds, new therapeutic targets, potential drug repurposing opportunities, and chemical starting points for the treatment of OAC.  

Methods

We have comprehensively profiled 19,555 small-molecule compounds using an innovative high content assay to quantify 1000’s of subcellular imaging features to capture important phenotypes missed by standard approaches. Prioritised molecules then underwent functional, transcriptomic, and metabolomic characterisation across panels of oesophageal cell lines and patient-derived organoids for the identification of OAC-specific drug mechanisms.

Results

We identified 72 lead compounds as exhibiting OAC-specific cytotoxicity and characterised three of the most potent and selective compounds in depth, each of different proposed classes and chemical structures. Using several orthogonal methods we uncovered a unified mechanism of action and a targetable vulnerability in OAC involving copper-dependent cell death.  Strikingly no phenotypic effects or changes in gene-expression were observed following treatment with these compounds in non-transformed oesophageal cell lines or normal gastric organoids providing support for this mechanism as a cancer-specific phenomenon.    

Conclusions

We have applied high content imaging, transcriptomic and metabolomic analyses to reveal a unique vulnerability in OAC.  We have defined a unified mechanism of OAC-specific copper-dependent cell death for the three highly potent compounds.  Finally, through the integration of transcriptomic and metabolomics analyses we gained insight into drug sensitivity and provide the basis for a future biomarker-stratified clinical trial of these drugs in OAC.
P-OGC39 The smell of oesophageal adenocarcinoma: opportunities for tests and treatments
Authors: Antonowicz Stefan , Abbassi-Ghadi Nima , Bodai Zsolt , Wiggins Tom , Markar Sheraz , Boshier Piers , Goh Yan Mei , Adam Mina , Lu Haonan , Kudo Hiromi , Rosini Francesca , Goldin Robert , Moralli Daniella , Green Catherine , Peters Chris , Habib Nagy , Gabra Hani , Fitzgerald Rebecca , Takats Zoltan , Hanna George
Published: December 2021

Background

Exhaled breath analysis is a promising approach for oesophageal adenocarcinoma (OAC) early detection. The biomarkers of interest are low molecular weight metabolites including volatile aldehydes. In this translational study we investigated whether these metabolites originated from a tumoral source, and how this might impact the diagnosis and treatment of OAC patients.

Methods

The investigative strategy was directed by an unbiased informatics screen of metabolic reprogramming in OAC, and validated using complimentary gene expression assays (n = 638, including controls). Mass spectrometric methods were used to quantify corresponding metabolites and putative source compounds at a tissue level (n = 158), and also in exhaled breath for correlative purposes. Targeted in vitro experiments were performed to demonstrate the cause and effect of the proposed model of metabolic reprogramming in OAC. 

Results

The unbiased screen and subsequent validation found that reduced aldehyde detoxification is an OAC hallmark. In vitro and in vivo this was associated with endogenous aldehyde accumulation. OAC tissue was generally enriched for volatile aldehydes, including the genotoxins formaldehyde, acetaldehyde, 4-hydroxy-2-nonenal and 2-butenal, and the exhaled biomarker decanal (all P < 0.0001). Decanal concentrations correlated with exhaled concentrations. Considering potential aldehyde sources, the OAC phospholipidome was characterised by desaturated and longer lipid acyls, and these spontaneously generated biomarker aldehyde species at ambient conditions. Enriched genotoxic aldehydes were detectable in base-pairing positions in DNA; this genotoxicity was therapeutically targetable with aldehyde scavengers in vitro.

Conclusions

These data support a model for enriched exhaled aldehydes based on increased production from an altered lipid phenotype, and reduced detoxification. Some aldehydes are non-reactive and thus support non-invasive detection. Others react with DNA and increase local genotoxicity; this process is druggable. These findings have implications for OAC early diagnosis and chemoprevention.
P-OGC41 Survival after curative chemoradiotherapy or neoadjuvant therapy and surgery converges in higher-risk patients with oesophageal cancer
Authors: Rana Mridul , Sanga Akshata , Sgromo Bruno , Gillies Richard , Marshall Robert , Maynard Nick , Ash Stephen , Antonowicz Stefan , Owen Richard
Published: December 2021

Background

Both curative chemoradiotherapy (cCRT) and neoadjuvant chemoradiotherapy and surgery (nCRTS) can be considered as treatments for potentially curable oesophageal squamous cell carcinoma (OSCC). Whilst this equipoise does not exist in oesophageal adenocarcinoma (OAC), there are patients in whom treatment decisions are not straightforward, creating an overlapping group in which cCRT might be considered in preference to neoadjuvant chemotherapy or chemoradiotherapy and surgery (nC(R)TS). We aim to see how survival changes between unmatched and matched cohorts of patients with OAC and OSCC treated with cCRT or nC(R)TS, to reflect difficult multidisciplinary team treatment decisions.

Methods

Patients treated with nC(R)TS or cCRT for OSCC and OAC were identified on an intention-to-treat basis from April 2016 to April 2019, allowing a minimum 2-year follow up from diagnosis. Upper third tumours were excluded due to clear preference for cCRT. Preoperative variables were compared using descriptive statistics, with OSCC and OAC analysed separately. Significantly different variables were used to generate propensity scores. Cohorts were then matched and analysis repeated to assess cohort symmetry. Overall survival and 2-year survival were investigated using Kaplan-Meier survival curves and log-rank testing. Analysis was performed in R.

Results

60 and 231 patients with OSCC and OAC were treated with cCRT or nC(R)TS. In the unmatched analysis, nC(R)TS had superior overall and 2-year survival, however there were significant differences in age, Charlson comorbidity index and cancer stage in OSCC and OAC cohorts, and in tumour site for the OAC cohort. After propensity score matching, differences in overall and 2-year survival reduced, though no results reached significance (OSCC: nCRTS 2y survival 58% vs 51% and 54% in unmatched and matched cCRT cohorts, respectively; OAC: cCRT 2y survival 51% vs 60% and 56% in unmatched and matched nC(R)TS cohorts, respectively).

Conclusions

These data suggest that as patient and cancer related factors increase the difficulty of treatment decisions, the survival benefit of surgery reduces in both OSCC and OAC. These results underline the need for randomised controlled trials using current treatment and staging strategies, as there have been considerable advances since original comparisons of neoadjuvant and curative chemoradiotherapy. This study is limited by relatively short follow up and unpowered sample sizes, however the coded nature of the analysis provides a structure for regular review of outcomes in our unit using routinely collected data, and could be easily applied more widely.
P-OGC46 Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-analysis
Authors: Tukanova Karina , Chidambaram Swathikan , Guidozzi Nadia , Hanna George , McGregor Alison , Markar Sheraz
Published: December 2021

Background

Esophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPC), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity. This meta-analysis aims to assess the impact of physiotherapy regimens following esophagectomy or gastrectomy.

Methods

An electronic database search was performed in MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases. A meta-analysis was performed to assess the impact of physiotherapy on the functional capacity, incidence of PPC and postoperative morbidity, in-hospital mortality rate, the Length of Hospital Stay (LOS) and the Health-Related Quality of Life (HRQoL).

Results

Seven RCTs and 7 cohort studies assessing prehabilitation totalling 960 patients, and 5 RCTs and 5 cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien-Dindo score >II). No difference was observed in functional exercise capacity, and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, a shorter LOS and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue and pain scores.

Conclusions

Our meta-analysis shows that implementing an exercise intervention may be beneficial in both the preoperative and peri- or postoperative period. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which subgroup of patients will gain the most benefit.
P-OGC47 Anastomotic stricture after Ivor Lewis Oesophagectomy - An evaluation of incidence, risk factors and treatment
Authors: Koshy Renol , Brown Joshua , Chmelo Jakub , Watkinson Thomas , Prasad Pooja , Phillips Alexander
Published: December 2021

Background

Anastomotic stricture is a recognised complication after oesophagectomy. It can impact the patient’s quality of life and may require recurrent dilatations. The aim of this study was to evaluate the frequency of benign strictures, contributing factors, and the long-term outcomes of management in patients undergoing oesophagectomy with thoracic anastomosis using a standardised circular stapler technique.

Methods

All patients who underwent a two-stage transthoracic oesophagectomy with curative intent between January 2010 and December 2019 at this single, high volume centre were included. All patients who underwent a stapled (circular) intrathoracic anastomosis using gastric conduits were included. Those with variations to anastomotic technique or those not having a transthoracic anastomosis were excluded to reduce heterogeneity. Patients who developed malignant anastomotic strictures and patients who died in hospital were excluded from the analysis. Benign stricture incidence, number of dilatations to resolve strictures, and refractory stricture rate were recorded and analysed.

Results

Overall, 705 patients were included with 192 (27.2%) developing benign strictures. Refractory strictures occurred in 38 patients (5.4%). One, two, and three dilatations were needed for resolution of symptoms in 46 (37.4%), 23 (18.7%), and 20 (16.3%) patients respectively. Multivariable analysis identified the occurrence of an anastomotic leak (OR 1.906, 95% CI 1.088-3.341, p = 0.024) and circular stapler size <28mm (OR 1.462, 95% CI 1.033-2.070, p = 0.032) as independent predictors of stricture occurrence. Patients with anastomotic leaks were more likely to develop refractory strictures (13.1% vs. 4.7%, OR 3.089, 95% CI 1.349-7.077, p = 0.008).

Conclusions

This study highlights that nearly 30% of patients having a circular stapled anastomosis will require dilatation after surgery for a benign anastomotic stricture. Although the majority will completely resolve after 2 dilatations, 5% will have longer-term problems with refractory strictures. Smaller circular stapler size and anastomotic leak have been identified as independent risk factors for developing a benign anastomotic stricture following oesophagectomy, and these patients should be monitored closely for symptomatology following surgery.