bluuebunny/crossref_metadata_2025 huggingface dataset:
P08 Routine group and save for elective laparoscopic cholecystectomy
Authors: Jenkin I , Sulutaura L , Skan O , Angheleanu R , Pizanias M , Howlader M , Chohda E , Lee H
Published: November 2022

Introduction

Laparoscopic cholecystectomy is the gold standard management for symptomatic cholelithiasis. Intraoperative vascular injury necessitating blood transfusion is a serious but rare complication, typically occurring during dissection around Calot's triangle or trocar insertion. Despite this, standard practice continues to incorporate the obtainment of historic and repeat group and save (G&S) samples to facilitate potential intraoperative transfusion of cross-matched blood. These are relatively expensive (£6.93/sample), time-consuming, and potentially distressing to patients. We review the requirement to obtain routine preoperative G&S samples whilst maintaining patient safety.

Methods

We performed a retrospective analysis of all patients having undergone elective laparoscopic cholecystectomy in a single centre during a six-month period in 2021. Seventy-nine patients were identified (53 female; 26 male), with a mean age of 52 years (range 22–80).

Results

All patients underwent historic G&S and 73% underwent same-day confirmatory samples. No patients required intraoperative or postoperative blood transfusion. Intraoperative bleeding occurred in two cases but neither required transfusion. Nineteen patients (24%) were admitted postoperatively for reasons including conversion to an open procedure (6%), uncontrolled pain, damage to surrounding structures, and the presence of multiple comorbidities.

Conclusion

As such, we propose that routine preoperative G&S samples are not required to undertake safe elective laparoscopic cholecystectomy. In the event of major vascular injury necessitating emergency intraoperative blood transfusion, the major haemorrhage protocol may be activated, and universal donor blood administered. However, routine G&S is recommended in the presence of significant comorbidities (e.g., bleeding diathesis), high likelihood of conversion to an open procedure, or preoperative anaemia.

Take-home message

Group and save samples are routinely obtained prior to elective laparoscopic cholecystectomy despite there very rarely being a need for intraoperative or postoperative blood transfusion. Based on our single centre, retrospective cohort study, we propose that such samples need not be obtained aside from in higher risk cases.
P10 Adherence to vte prophylaxis guidelines in general surgical patients: a single-centre study
Authors: Hussein A , Songra L , Baker D
Published: November 2022

Introduction

Hospital acquired venous thromboembolism (VTE) is potentially preventable yet still accounts for 60% of all VTE seen. This study aimed to establish adherence to guidelines on VTE prevention including completion of VTE risk assessment within 24 hours of admission and appropriate prescription of mechanical and pharmacological VTE prophylaxis.

Methods

A database of all general surgical inpatients in our hospital at any point during the 48-hour period from 21/12/2021 to 22/12/2021 was obtained. Electronic records were examined to check for the presence of 11 established risk factors for VTE and to check for adherence to VTE guidelines. Every surgical patient was reviewed to check whether they were wearing anti-embolic stockings. Standard statistical analyses were undertaken.

Results

There were 107 general surgical patients in hospital during the study period. Of these, 33 (31%) had 3 or more risk factors on admission for VTE. 106 (99%) patients had VTE assessments completed within 24 hours of admission. Of these 107 patients, 93 (87%) had appropriate pharmacological VTE prophylaxis or had a documented reason why this was not prescribed. 14 (13%) patients had no pharmacological VTE prophylaxis prescribed. 84 patients were assessed as requiring anti-embolic stockings. Of these, 57 (68%) of patients were prescribed stockings, and 30 (36%) were physically wearing stockings.

Conclusion

This study has shown that adherence to VTE guidelines among surgical patients in our hospital is substandard. We suggest having a VTE safeguard during the ward round responsible for identifying any deficits in VTE prophylaxis and ensuring recommendations are acted upon.

Take-home message

VTE guidelines among surgical patients is substandard. We suggest having a VTE safeguard during the ward round responsible for identifying any deficits in VTE prophylaxis and ensuring recommendations are acted upon.
P11 Variations in subjective and objective metabolic equivalents in patients undergoing aortic surgery
Authors: Yang PZ , Choy B , Hamid H
Published: November 2022

Introduction

Metabolic equivalents (METs) are measures of patient's functional capacity. It provides insight into patient's risk of perioperative complications. METs are usually obtained from estimation based on patient's history or by cardiopulmonary exercise testing (CPET). However, the validity of estimated METs has been questioned in multiple studies. In this study, we sought to compare the subjective METs from preoperative evaluation and objective METs derived from CPET, to investigate the reliability and validity of subjective METs.

Methods

A retrospective study was carried out for patients scheduled for aortic surgery from March 2017 to September 2018. Patients were classified into 3 subjective categories: Poor (< 4 METs), Moderate (4–10 METs) and Good (> 10 METs), whereas objective METs values were obtained from CPET. Comparative analysis between patient's objective METs and subjective METs was carried out to identify any variations.

Results

Subjective METs correlate with objective METs. Although subjective METs tends to overestimate patient's functional capacity, leading to 44.4% misclassified in the Moderate category. In contrast, Poor category only misclassified 5% by underestimation. In addition, the results confirmed significant differences between the Moderate and Poor categories as expected.

Conclusion

Although subjective METs categories correlate with objective METs, it tends to overestimate patient's METs. They are more accurate in identifying patients with Poor functional capacity (< 4 METs). Therefore, it is a convenient tool for clinician to effectively exclude patients with Poor METs. However, use of subjective METs should be considered carefully due to its limitation in estimating Moderate or Good METs.

Take-home message

Subjective metabolic equivalents correlate with objective metabolic equivalents.
P13 Understanding unwarranted variation in surgical outcome - a Delphi study with perioperative professionals.
Authors: Stubbs DJ , Bashford TH , Nourallah B , Ercole A , Clarkson PJ , Levy N
Published: November 2022

Introduction

Current assessment of perioperative risk relies on patient and surgical factors. However, risk stratification is imperfect and significant unwarranted variation in outcome persists. We sought to identify factors that may influence outcome, but which are under-represented in the literature.

Methods

We used process mapping of stereotyped surgical pathways to identify participants for a multidisciplinary, three round Delphi across two United Kingdom hospitals. A three-round Delphi of 91 stakeholders, from 23 professional groups was conducted. Using a 5-point Likert-scale consensus was defined as a median of >3.5 or <2.5 with an interquartile range of <1.

Results

Response rates were Round one: 51%, round two: 38%, round three: 19%. In round one free text panel suggestions were combined with variables from existing risk scores. This yielded 410 variables. With new suggestions from round two, 468/519 (90%) of the statements ultimately presented to the panel reached consensus. These included patient factors (such as ethnicity and socio-economic status); organisational or process factors related to the hospital (such as policies, staffing, and organisational culture). 66/160 (41%) of the new suggestions did not feature in systematic reviews of perioperative risk scores or key process indicators. No factor categorised as ‘organisational’ (such as organisational culture or external pressures) was present in any examined perioperative risk score.

Conclusion

We identified broader insights into additional factors that may underlie variation in outcome based on the expertise of perioperative professionals. These results could support future research into how organisational structure and performance influences patient outcome.

Take-home message

Perioperative professionals view factors outside of patient and clinician control as relating to surgical outcome. Such factors appear to be absent from many commonly used risk stratification tools.
P14 Evaluation of clinical prognostic variables on short-term outcomes for colorectal cancer surgery: an overview and minimum dataset
Authors: Cheong CM , Golder A , Horgan P , Roxburgh C , McMillan D
Published: November 2022

Introduction

Colorectal cancer resection remains a cause for morbidity and mortality despite the potential curative intent. Multiple systematic reviews have reported on individual factors affecting short term outcome following surgical resection. This umbrella review aims to synthesize the available evidence on host and other factors associated with short-term post-operative complications.

Methods

A systematic search identified systematic reviews reporting on short-term outcomes following colorectal cancer surgery. PubMed, Cochrane Database of Systematic Reviews and Web of Science were search from inception to 8 September 2020. All reported clinicopathological variables were extracted from included systematic reviews.

Results

This overview has identified multiple validated factors affecting short-term outcomes in patients undergoing colorectal cancer resection. There are multiple prognostic factors that affect the short term outcome following colorectal cancer resection although the association differs dependent on the type of complication; infective; non-infective or mortality. The presence of diabetes and measurements of body composition were both factors consistently associated across the short term outcome measures. Despite the large body of literature available, the heterogeneous nature of included prognostic factors and reported outcomes create a challenge for comparing outcomes.

Conclusion

A minimum dataset of mandatory, recommended, and potential baseline variables to be included in studies of patients undergoing colorectal cancer resection is proposed. This will maximize the benefit of such study databases.

Take-home message

The reported effect of prognostic risk factors associated with colorectal cancer resection vary dependent on outcome of interest. This highlights the shortcomings of the current literature and understand of outcomes in colorectal cancer which could be improved with a minimum dataset of baseline variables in future studies.
P15 Audit of outcome of ambulatory care emergency surgery patients
Authors: Walker H , Freer R , Angamuthu N , Hart C
Published: November 2022

Introduction

A proportion of emergency surgical patients are discharged with outstanding tasks (clinical review, imaging to be requested or results followed-up) pending. The turnaround time of these tasks typically placed at the bottom of the emergency surgical on-call list is dependent on the on-call registrar or house officer. The aim was to analyse the outcomes of pending tasks on ambulatory care emergency surgical patients and explore means to improve.

Methods

A retrospective audit of emergency surgical patients from October to December 2021 was performed using the daily on-call list database.

Results

Among the 149 patients with pending tasks on an ambulatory care basis, 80 were excluded (duplicate entries, unclear tasks, non-valid reasons). 38% of patients remained on the list for more than 24 hours with pending tasks. Only 75% of patients had pending tasks completed. Patients waited for 3.3 hours on average (59 to 350 minutes) for clinical review by the registrar or house-officer. The reasons for the delay in clinical review and task completion narrowed down to inappropriate timing (scheduled return in the mornings, when the on-call team are either busy with the ward round or in theatres) and time restraints.

Conclusion

Based on the above findings, it would be beneficial for our hospital to have a surgical hot clinic with staggered appointments rather than ad hoc return to the ambulatory unit. This would improve waiting times and would allow outstanding tasks to be completed by the surgical registrar or clinical fellow during clinic, increasing patient satisfaction.

Take-home message

A dedicated surgical hot clinic will reduce patient waiting times, increase overall patient satisfaction and ensure completion of outstanding clinical tasks.
P19 Audit of completion and documentation of neurovascular assessment prior to, and after Bier's block for distal radius fracture
Authors: Nwose S , AkiiBua A , Hussein M
Published: November 2022

Introduction

The BOAST guideline's standard of practise for the management of distal Radius Fractures states that assessment of circulation and sensation should be documented prior to and after MUA for distal radius fractures. We measured the compliance of the completion and documentation of the neurovascular assessment prior to and after Bier's Block for MUA of distal radius fractures.

Methods

We assessed electronic medical records of these patients during the period November/December 2020. Focusing on the completion of the neurovascular assessment and documentation prior to Bier's Block and compared the results to our first cycle audit done in July/August 2020 following our intervention.

Results

58 patients were analysed for this study compared to 50 in the initial study. 88% had neurovascular assessment done and documented in the Emergency Department compared to 98% in the initial study. However, 60.3% had documentation of neurovascular assessment prior to Bier's block compared to 34% previously. 39.7% had vascular assessment after Bier's block and 64% had neurovascular assessment done in fracture clinic in this second cycle compared to 22% and 76% for vascular assessment and Neurovascular assessment in the facture clinic respectively after the MUA.

Conclusion

This re- audit shows an improvement in the assessment and documentation of neurovascular Status prior to and following MUA of distal radius fracture. There is however a need for improvement. Suggested methods include teaching of upper limb neurological assessment to orthopaedic juniors, Aide memoire such as a small sticker to attach to the notes/ Stamp in the fracture clinic notes.

Take-home message

Assessing and documenting neurovascular status before and after an MUA is very important.
P20 Pre-operative checklist to improve pathway for carotid endarterectomy (CEA) patients: a single centre audit
Authors: Wilcock D , Marzouqa N , Weerakkody R , Baker DM
Published: November 2022

Introduction

The SARS-COV-2 pandemic has led to the redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOP) was proposed. An audit was undertaken to evaluate the SOP, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements.

Methods

To ascertain key pre-operative steps to include in the checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once the checklist was established the questionnaire was re-sent additionally asking for feedback on its impact on the service and suggestions for improvement. Using these results, the checklist was incorporated as a smart text to EPIC (electronic patient notes).

Results

The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt the checklist improved the service in all domains, except bed availability and subsequent surgical delay, likely because this depended on HDU bed availability and need for on-the-day prioritisation.

Conclusion

The CEA surgery checklist is now an established part of the electronic patient record in the form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of the team including new/temporary staff can follow this, ensuring a safe care pathway.

Take-home message

With the move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by the use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.
P22 Postoperative and pathological outcomes of CROSS and FLOT as neo-adjuvant therapy for oesophageal and junctional adenocarcinoma: an international cohort study from the Oesophagogastric Anastomosis Audit (OGAA)
Authors:   Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative
Published: November 2022

Introduction

Ongoing debate exists around optimum approach to locally advanced esophageal adenocarcinoma (EAC), with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen. This study aimed to compare the postoperative and pathological outcomes between CROSS and FLOT in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort.

Methods

Patients undergoing CROSS (n=350) and FLOT (n=368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit (OGAA).

Results

The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, p=0.005), even on adjusted analyses (odds ratio (OR): 3.97, CI95%: 1.34–13.67). Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pCR rates (18% vs 10%, p=0.004) and margin-negative resections (93% vs 76%, p<0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI95%: 1.26–3.34) and margin-negative resections (OR: 4.55, CI95%: 2.70–7.69) compared to FLOT.

Conclusion

This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long term survival is needed.
O001 SARS-CoV-2 pandemic has impacted on patterns of aetiology for acute pancreatitis and management of gallstone pancreatitis in the United Kingdom
Authors: Spiers HVM , Nayar M , Pandanaboyana S
Published: November 2022

Introduction

The impact of the SARS-CoV-2 pandemic on patterns of aetiology of acute pancreatitis (AP) and management of AP in the UK is unknown.

Methods

A prospective multicentre cohort study of consecutive patients admitted with AP between 01/03/2020 and 23/07/2020 was undertaken. Patients were followed up for 12 months.

Results

1628 patients presenting with AP were included in the analysis. Gallstones (GSP) were the predominant aetiology (43.6%), followed by alcohol associated (25.8) and idiopathic (21.5%) AP. After completing aetiological investigations, 14.4% of the idiopathic cohort remained to have an idiopathic aetiology. 113/187 patients were readmitted during the ‘second wave’ of SARS-CoV-2 pandemic (after September 2020) with predominantly alcohol-related AP aetiology (49, 43.3%). Patients readmitted during the ‘second wave’, more commonly had alcoholic AP compared to the index cohort (43.4% vs 23.5% respectively; p<0.001); however, there were no significant differences in AP severity (p=0.268). Of the 1358 patients with complete follow-up data, 620 (45.7%) presented with GSP of which only 66 (10.6%) underwent index cholecystectomy and 108 (17.4%) had an interval cholecystectomy with median waiting time of 32 days (IQR 16–56). Accounting for 44/456 patients with previous cholecystectomies, and 24 patients deemed unfit for cholecystectomy, the remaining 388 (77.3%) were still awaiting cholecystectomy at the end of 12 months.

Conclusion

The patterns of aetiology for AP changed during the SARS-CoV-2 pandemic with an increase in alcohol associated AP. Most significantly, access to cholecystectomy was restricted during the pandemic and readmission to hospital may have been driven by the need for cholecystectomy.

Take-home message

The patterns of aetiology for AP changed during the SARS-CoV-2 pandemic with an increase in alcohol associated AP. Most significantly, access to cholecystectomy was restricted during the pandemic and readmission to hospital may have been driven by the need for cholecystectomy.
O003 Radiation-related chromosomal aberrations observed in high volume endovascular operators performing X-ray guided surgery
Authors: Abdelhalim MA , Patel A , Moquet J , Smith A , Badie C , Anderson R , Ainsbury E , Modarai B
Published: November 2022

Introduction

The biological effects of chronic, low dose radiation, to which operators performing fluoroscopy-guided procedures are exposed, are unknown. We have previously demonstrated acute DNA damage/repair in lymphocytes from operators performing fluoroscopy-guided endovascular aneurysm repair (EVAR), but these markers normalised after 24 hours and did not inform on the residual accumulated effects of chronic radiation exposure. In the present study cytogenetic techniques were used to examine for chromosomal aberrations in endovascular operators.

Methods

Peripheral blood lymphocytes were isolated from high volume endovascular operators performing EVAR and age-matched radiation naïve general surgeons as controls. Giemsa staining was used to visualise the full complement of chromosomes and all dicentrics, where 2 centromeres are present in a single chromosome, were identified. The genome was analysed for abnormal exchanges of genetic material between chromosomes using multiplex fluorescence in situ hybridisation (mFISH).

Results

Lymphocytes from 18 operators (12 exposed, 6 controls) were analysed. A higher frequency of dicentric chromosomes were found in exposed operators compared with controls (0.0011 vs 0.0004, respectively, P=0.002) after examining 54,000 lymphocytes. Twice as many complex chromosome rearrangements were seen in endovascular operators compared with controls (0.48% vs 0.24%). Aneuploidy, the abnormal loss of chromosomes, was more frequent in endovascular operators with a median difference of 0.35 per chromosome (P=0.004).

Conclusion

We have found a higher frequency of chromosomal aberrations in endovascular operators compared with radiation naïve colleagues. This justifies further individual biological profiling for genomic instability and personalised radiation risk assessment.

Take-home message

Radiation-related DNA damage occurs in endovascular operators despite current radiation protection measures. Biological dosimetry could be a useful tool, allowing personalised risk assessment.
O004 Blood group antigen removal of a human kidney using ex-vivo normothermic machine perfusion technology
Authors: MacMillan S , Hosgood SA , Nicholson ML
Published: November 2022

Introduction

A novel strategy to overcome the constraints of ABO compatibility in solid organ transplantation is the enzymatic removal of blood group antigens using an alpha-galactosidase enzyme from Bacteroides fragilis during ex-vivo normothermic machine perfusion (NMP).

Methods

Human kidneys rejected for transplantation and offered for research were used in this study which was approved by the National Research Ethics committee and Research and Development office (NRES: 15/NE/0408). Blood group antigen removal using the alpha-galactosidase enzyme GH110B from B. fragilis was first investigated on formalin-fixed paraffin-embedded (FFPE) cortex sections from human kidneys of blood group B (n=5). Immunofluorescence co-staining of the blood group B antigens (isolectin GSIB4) and vascular endothelium (CD-31) was completed. A human kidney of blood group B was then treated with 0.0025mg/ml of alpha-galactosidase during 6hrs of NMP using an acellular perfusate solution. Serial biopsies taken throughout perfusion were stained and analysed for antigen removal.

Results

Alpha-galactosidase treatment of FFPE sections at all concentrations examined (0.0013mg/ml 0.5mg/ml) caused significant reduction of the Pearson correlation coefficient for B antigen and CD-31 co-localisation compared to the untreated control (p<0.001). Following NMP of the treated B kidney, the Pearson correlation coefficient dropped from 0.182±0.042 (pre-treatment level) to a minimum of 0.017±0.102 after 6hrs (p<0.0001), indicating a near-complete loss of the blood group antigens.

Conclusion

This is the first example of the enzymatic removal of type B blood group antigens from a human kidney during NMP. This strategy may have the potential to increase the pool of ABO compatible donor kidneys for transplantation.

Take-home message

We have shown that an alpha-galactosidase enzyme added during ex-vivo normothermic machine perfusion can be used to enzymatically remove the blood group B antigens from human kidneys, providing the first example of whole organ conversion in humans. This strategy has the potential to massively increase the pool of ABO compatible donor kidneys for transplantation.
O008 Are donor paediatric pancreatic grafts a viable option for pancreas transplantation, even in an adult recipient?
Authors: Tinker RJ , Owen RV , Tiwari N , Wilson CH , White SA
Published: November 2022

Introduction

Very few studies have analysed the outcomes of paediatric pancreatic grafts for whole pancreas transplantation. These grafts represent an important resource for both paediatric and adult recipients. Smaller donor grafts may have an increased risk of thrombosis and potentially less chance of insulin independence due to reduced beta cell mass in larger recipients. The aim of this study was to analysis of the use of donor paediatric pancreatic grafts for whole pancreas transplants.

Methods

NHSBT registry data from 2003–2021 was obtained (n=2,998), those with missing data specifically pertaining to paediatric grafts were removed leaving a final cohort of 2,812. Age groups were categorized by school year (pre-school, infants, junior and high-school students) to best represent paediatric growth and milestones. Univariate survival analysis was performed using Kaplan Meier plots and multi-variate analysis with cox regression models.

Results

The majority of grafts utilized were from donors >18 years old (n=2,402, 85.4%). 12.4% (n=350) were aged between 12–18 years, 1.45% (n=41) 8–11 years, 0.6% (n=17) 4–7 years and our smallest group aged <4 years 0.07% (n=2). We accept numbers are small for the youngest cohorts but there were no statistically significant differences between the different age groups in terms of either graft survival at 1 year (p=0.707) or 3 years (p=0.129) or patient survival at 1 year (p=0.06) or at 3 years (p=0.30).

Conclusion

This study has shown comparable graft and patient outcomes after pancreas transplantation irrespective of donor age and may help facilitate improved rates of graft utilization.

Take-home message

Paediatric donors have very similar outcomes to adult donors. Here we provided evidence that paediatric transplants for the pancreas should be more widely utilised.
O012 The role of the anti-miR-135/Spock1 axis on metabolism and drug response in intestinal/colon tumour organoids
Authors: Nateri AS , Babaei-Jadidi R. , Kashfi H , Alelwani W , Bakhtiari A , Kattan SW , Mansouri OA , Mukherjee A , Lobo DN
Published: November 2022

Introduction

Little is known about the role of microRNAs (miRNAs) in rewiring the metabolism within tumours and adjacent non-tumour bearing normal tissue and their potential in cancer therapy. This study aimed to investigate the relationship between deregulated miRNAs and metabolic components in murine duodenal polyps and non-polyp-derived organoids (mPOs and mNPOs) from a double mutant Apc/Fbxw7 mouse model of intestinal/colorectal cancer (CRC).

Methods

We measured glucose consumption and lactate production, and analysed the expression of 373 miRNAs and 12 metabolic genes using qRT-PCR and Western blotting in mPOs and mNPOs. The overexpressed miRNAs systematically target metabolic genes explored by the TargetScan web server. Organoid viability was assessed using MTT and Sulforhodamine-B (SRB) colorimetric assays.

Results

The tumour and adjacent non-tumour organoids showed differential metabolic activity. mPOs showed elevated lactate and consumption of glucose in the medium. Murine Apc/Fbxw7 duodenal polyp-derived organoids mimicked colorectal cancer patient-derived organoids. Our findings revealed miR-135b might target Spock1. Upregulation of SPOCK1 correlated with advanced stages of CRCs. Knockdown of miR-135b decreased the expression level of SPOCK1, glucose consumption and lactic secretion in CRC patient-derived tumours organoids (CRC tPDOs). Increased SPOCK1 induced by miR-135b overexpression promoted the Warburg effect and consequently antitumour effect of 5-fluorouracil.

Conclusion

Combination with miR-135b antisense nucleotides may represent a novel strategy to sensitise CRC to the chemo-reagent based treatment.

Take-home message

Our data highlight the therapeutic potential of targeting miR-135/SPOCK1 to enhance the treatment of colorectal cancer.
O013 The increasing burden of the two-week wait colorectal cancer pathway within a single centre
Authors: Farkas N , O’Brien JW , Palyvos L , Maclean W , Benton S , Rockall T , Jourdan I
Published: November 2022

Introduction

Increasing demand has placed colorectal cancer (CRC) two-week wait (TWW) pathways under pressure. The primary aims of this paper are to review TWW referral numbers and CRC diagnoses within our centre over the past 3 years (before, during and in recovery from the COVID-19 pandemic) and compare outcomes to our previously published data (2009–18). This incorporates the introduction of FIT into our clinical practice.

Methods

TWW CRC referral data from 1st July 2018–31st July 2021 was analysed. Parameters assessed; monthly TWW referrals, CRC detection, % of TWW referrals seen <14 days and investigations utilised. Data from January 2009 to 31 June 2018 was combined. Unpaired t-test was used to compare group means.

Results

TWW referrals have increased 360% from 2009 to 2020. The proportion of TWW referrals with CRC has decreased from 8.87% to 3.24% over this period, whilst the incidence of CRC remained static (mean 58.7 per annum). From 2009–18, TWW referrals=8921, CRC diagnoses=533, mean monthly CRC detection rate=4.7, ratio of referrals to CRC=16.7:1. From 2018–21, TWW referrals= 6523, CRC diagnoses=232, mean monthly CRC detection rate=6.3, ratio of referrals to CRC=28.4:1. There was a statistically significant difference in mean monthly referrals (p-value<0.00001) between the two periods.

Conclusion

Despite ever-increasing TWW referral numbers, no significant change in CRC diagnoses has occurred. We find our service under ever-increasing strain. Additional strategies and guidance are required to help address this. Further studies evaluating FIT and repeat FIT in the symptomatic TWW cohort may have a role in generating such a consensus.

Take-home message

Two week wait colorectal cancer referrals have increased 360% in 12 years. Colorectal cancer detection rate remains static over this timeframe.
O015 Discharge oral nutritional supplements on outcomes after gastrointestinal surgery: a systematic review and meta-analysis
Authors: Rowley A , Adiamah A , Kushairi A , Lewis S , Lobo DN
Published: November 2022

Introduction

Malnutrition is a risk factor for adverse postoperative outcomes. This systematic review and meta-analysis aimed to evaluate the impact of post-discharge oral nutritional supplements (ONS) on outcomes in patients undergoing gastrointestinal surgery.

Methods

The Medline, Embase and Cochrane databases were searched for randomised controlled trials (RCTs) in patients undergoing gastrointestinal surgery who had received ONS for at least two weeks after discharge from hospital. The primary endpoint was weight change. The secondary endpoints included quality of life, total lymphocyte count, change in grip strength and body composition. Analysis was performed using RevMan5.4 software.

Results

Sixteen studies were included with 1789 participants (903 in intervention group and 886 controls). Pooling of results in a meta-analysis revealed that there was significantly less weight loss in patients taking ONS, when compared with controls: overall OR=-1.36 (CI -2.48 to -0.23), P=0.02. Albumin concentration was significantly higher in the ONS group [OR=0.11 (95% CI 0.06 to 0.16) I2=0%, P=0.45]. Total lymphocyte count was also higher in the ONS group [OR=200.75/ml (95% CI 75.53 to 325.98/ml), I2=0%, P=0.76]. However, post-discharge complications and quality of life did not differ between the two groups. Patient compliance was relatively poor across the studies and there was variability in the volume and composition of ONS.

Conclusion

Overall, there was a reduction of weight loss and an improvement in other nutritional markers in patients taking ONS. However, future RCTs with more consistent methodologies are needed to investigate the efficacy of different ONS types on different patient sub-populations.

Take-home message

Oral nutritional supplements may be considered as standard care for certain patients after gastrointestinal surgery.
O016 Antibiotics versus appendicectomy for uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials
Authors: Herrod PJJ , Kwok AT , Lobo DN
Published: November 2022

Introduction

Previous meta-analyses of randomised controlled trials (RCTs) on patients with uncomplicated acute appendicitis have demonstrated reduced complication rates with primary antibiotic therapy when compared with appendicectomy. This aim of this systematic review and meta-analysis of RCTs was to provide an update of the efficacy of antibiotic therapy compared with appendicectomy in adult patients with uncomplicated acute appendicitis.

Methods

MEDLINE, EMBASE and CENTRAL databases were searched with no date or language restriction. Data on complications of treatment, treatment efficacy (defined in the antibiotic group as not undergoing appendicectomy at 1 year, versus surgery without complications or negative histology in the appendicectomy group), readmissions, and length of stay (LOS) were extracted.

Results

We included 8 RCTs involving 3203 participants (1613 antibiotics/1590 appendicectomy; 2041 males/1162 females). Antibiotics had a reduced treatment efficacy compared with primary appendicectomy (RR 0.75, 95% CI 0.63–0.89). There was no significant benefit of primary antibiotic treatment on complication rates (RR 0.66 95% CI 0.41–1.04). In total 1010/1613 (62.6%) patients had successful antibiotic treatment at 1 year. In the 5 studies which explicitly reported hospital re-admission as an outcome, primary antibiotic treatment had a six-fold increase in readmissions (RR 6.28 95% CI 2.87–13.74). There was no difference in index admission LOS [Mean Difference 0.15 days (95%CI -0.05–0.35)].

Conclusion

Primary antibiotic treatment for acute appendicitis is associated with a reduced treatment efficacy and a significant readmission rate, without any benefit on complications or LOS. Approximately 40% of patients initially treated with antibiotics will require surgery within 1 year.

Take-home message

Contrary to previous meta-analyses, the current study suggests that although primary antibiotic therapy may be tried for uncomplicated acute appendicitis in adults, it is not definitive treatment in the long term.
O017 The virtual surgical specialty series: a platform for undergraduate surgical exposure during the pandemic
Authors: Hinchcliffe Z , Remsudeen R
Published: November 2022

Introduction

COVID-19 drastically disrupted medical education, with large proportions of teaching now delivered virtually. It is often challenging to replace face-to-face clinical placements, reducing student exposure to different specialities. The Surgical Specialty Series was created to provide a holistic understanding of various sub-specialties while restrictions to surgical placements existed. This study aimed to investigate the efficacy of our series in improving exposure and interest to surgical careers during the pandemic.

Methods

The series was delivered between October-May 2020/21, covering seven surgical specialties. Each month, three webinars were delivered by surgeons (varying grades), focussing on career pathways, post-graduate teaching and undergraduate revision. All sessions were advertised using social media and delivered via Zoom using online teaching tools (polls, screen-sharing, surgical videos). A feedback form was distributed for data analysis.

Results

The series saw 1124 total attendees (38–107 per webinar): 29.2% were from the home university, 25.9% were from other UK-based institutions and 44.8% were from overseas. Overall, a 21.6% increase was observed in student interest to pursue a surgical career. Although 24.2% of attendees were unsure beforehand, 13.4% developed a surgical interest after. Interactive polls and videos were reported most useful and enjoyable in student learning.

Conclusion

The virtual series was an effective alternative to in-person clinical attachments in raising awareness and undergraduate interest in surgery, despite COVID-19. It was beneficial in widening access to quality medical education, particularly to students overseas. Successes of this series should be considered when shaping the future of undergraduate surgical education in the ongoing pandemic.

Take-home message

The online webinar series was an effective alternative to in-person clinical attachments, through increasing surgical interest amongst medical students. Successes of this series should be considered when shaping the future of undergraduate surgical education in the ongoing pandemic.
O019 Comparison of skin substitute materials for use in remote surgical skill education
Authors: Awad L , Langridge B , Jeon F , Bollen E , Butler P E.M.
Published: November 2022

Introduction

Simulation training is increasing in popularity within the medical field. It provides a safe, reproducible environment in which learners can build upon surgical skills. The current pandemic has reduced workplace opportunities for learning, with decreased theatre opportunities and a high volume of trainees seeking training. In order for realistic skill development synthetic substitute materials have a role in facilitating training of suturing, excision, local flaps and other skills. The aims of this review were to compare commercially available synthetic materials for use in remote surgical skill training.

Methods

8 commercially available skin substitutes were included in this review; felt, foam dressing, a generic silicone skin pad, Sigma Lance Basic, Sigma Lance Advanced, Sigma Lance Infinity, Suture Doctor, and Limbs & Things. A questionnaire was distributed to 30 medical students, surgical trainees and consultants consisting of 8 criteria pertaining to surgical skills and similarity to skin. Cutometry and durometry data was obtained and compared to skin on the face, arm and back of 3 healthy participants under the age of 30.

Results

Overall, felt had the poorest outcomes in all domains. Foam dressing was comparable to skin on the face, back and arm for both cutometry and durometry. Foam dressing was comparable to commercially available skin pad results in the questionnaire.

Conclusion

Foam dressings are comparable to commercially available skin pads in application of surgical skills, and are a cost-effective alternative to facilitate delivery of remote training of surgical trainees.

Take-home message

Foam dressings constitute an alternative, comparable and cost-effective synthetic material for remote surgical skill development, particularly suturing, excision and local flap design.
O022 Application of customised 3D printed models to aid undergraduate teaching and surgical planning in hepatobiliary surgery
Authors: Edhem L , Dixon L , Jones J , Bahri S , Maxwell-Armstrong C
Published: November 2022

Introduction

3D-printing in maxillofacial surgery has been used for several years to construct bespoke prostheses prior to surgical procedures. This work aims to assess whether its role can be

expanded into undergraduate teaching and surgical planning in hepatobiliary surgery.

Methods

Four patient CT scans with liver and renal pathology were deemed eligible for printing. A computer aided design was constructed for each scan, segmenting the organ, lesion, and vasculature. One kidney and three liver models were printed. Production time of the models ranged from 31 to 106 hours. One liver model with the associated CT scan was shown to 20 doctors of varying experience. They were asked to complete a survey evaluating its potential in surgery, aiding patient education, and anatomy education. The remaining models were used in an anatomy tutorial for 6 medical students, who were requested to complete a pre-and-post-session survey evaluating the potential for the 3D models in anatomy education.

Results

An average rating from the NHS-staff survey was 6.9 for pre-operative planning, 8.65 for aiding anatomy education, and 9.15 for potential use in patient education. Following the tutorial with the models, 4 of the 6 students felt their overall understanding of liver anatomy improved. In particular, all students expressed increased confidence in hepatic segmentation anatomy.

Conclusion

Our work shows that 3D-printed models can provide benefit in aiding clinical teaching and patient information. Future work will focus on use of the models as an aid to patient education in an outpatient setting.

Take-home message

3D-printed models have a future in aiding anatomy education and hepatobiliary surgical planning. Further research can consolidate their applications.
O023 Artificial intelligence in photography of normothermic machine perfusion of livers
Authors: El-Rhalibi A , Wilson C , Nasralla D
Published: November 2022

Introduction

Livers donated for use in transplantation are underutilised. A lack of clear guidelines regarding the visual assessment of their quality means many borderline grafts are needlessly discarded; macroscopic visual assessment by transplanting clinicians is subjective and inconsistent. Deep learning (DL), a form of artificial intelligence, has previously been used to aid medical image analysis. Normothermic machine perfusion (NMP) is often used to evaluate borderline livers for transplantation. This study aimed to develop an objective DL model to visually assess organ transplantability during NMP.

Methods

Five DL models were trained and tested on 100 images of donor livers, each labelled with scores from three transplant clinicians on steatosis, perfusion, and transplantability. Models were trained to classify liver transplantability through either image data and transplantability scoring data, or image data and all clinician scoring data. Model accuracy, specificity, and sensitivity were calculated. Evaluations of clinician scoring agreement were carried out using intraclass correlation coefficient (ICC) and Fleiss kappa.

Results

In the classification of transplantability, the highest performing models achieved training and testing accuracies of 64.3% and 76%, respectively. Sensitivity and specificity ranged between 44.1%–94.1% and 6.3%–75%, respectively. ICC and Fleiss kappa values indicated a fair-to moderate scoring agreement between clinicians.

Conclusion

The performance of DL image analysis in assessing liver quality during NMP has been modest. Visual assessment during NMP is more challenging than on the back table at organ retrieval. Broader, more varied data sets are required to maximise model performance.

Take-home message

Livers donated for use in transplantation are underutilised due to a lack of clear guidelines and the subjective nature of their visual assessment. Artificial intelligence can be used to consistently and objectively assess donated livers in order to improve their utilisation.
O024 Prognostic value of haemodynamic parameters in predicting adverse clinical events in type B aortic dissection
Authors: Yang QZC , Hanna L , Statton B , Armour C , ORegan D , Xu Y , Gibbs R
Published: November 2022

Introduction

Ascertain the prognostic role of in-vivo 4D-flow magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) aortic haemodynamic parameters as predictors of adverse dissection-related events in type B aortic dissection (TBAD).

Methods

A systematic literature search was conducted according to the PRISMA guidelines using electronic databases searched from 1946 to 2021 for studies reporting on the relationship between aortic haemodynamics and aortic dissection-related events defined as aortic growth, aneurysm development, false lumen thrombosis, need for surgery and aortic rupture.

Results

Fourteen studies were included; eleven studies used CFD and three studies used 4D-flow MRI. Two studies found increased FL ejection fraction (EF) significantly associated with aortic growth rate, and another study found increased FL stroke volume significantly associated with increased aortic expansion rate. Result for time-averaged wall shear stress (TAWSS) and relative residence time (RRT) are contradictory; one study found TAWSS significantly associated with aortic wall deformation, but another study found no significant difference. Five studies suggested possible associations between slow flowing regions or increased RRT and FL thrombosis, with another study finding significant associations between FL thrombosis and adverse aortic outcomes. However, one study revealed opposite findings where decreased RRT significantly correlated with aneurysm formation.

Conclusion

In-vivo aortic haemodynamic measurements such as FL EF, FL stroke volume, TAWSS and RRT show possible associations with FL and aortic expansion, as well as FL thrombosis. Larger prospective studies are now needed to determine the prognostic utility of in vivo aortic haemodynamic metrics in predicting TBAD clinical outcomes to guide management.

Take-home message

Aortic haemodynamic parameters measured by 4D-flow magnetic resonance imaging and computational fluid dynamics show promising potential as predictors of adverse dissection-related events in type B aortic dissection.