bluuebunny/crossref_metadata_2025 huggingface dataset:
OGC O01 Delayed surgical Intervention after Chemoradiotherapy in Esophageal cancer (DICE) study
Authors: Chidambaram Swathikan , Sgromo Bruno , Maynard Nick , Markar Sheraz
Published: December 2022

Background

Chemoradiotherapy (CRT) is a core component of curative treatment for esophageal cancer for locally advanced esophageal cancer. Salvage esophagectomy is undertaken in patients who experience recurrent or residual cancer post-CRT. This study aims determine the impact of delayed surgical intervention following chemoradiotherapy on survival from oesophageal cancer.

Methods

This was an international, multi-center, retrospective cohort study involving seventeen tertiary international centers, including patients who received CRT followed by surgery between 2010–2020. In the main analysis patients were divided into four groups based upon the interval between chemoradiotherapy and surgery (0–50, 51–100, 101–200 and >200 days) to assess the impact upon 90-day mortality and 5-year overall survival (OS). Multivariable logistic and Cox regression provided hazard rations (HRs) with 95% confidence intervals (95%CI) adjusted for relevant patient, oncological and pathological confounding factors.

Results

2,867 patients who underwent oesophagectomy after CRT were included. The mean age of the cohort was 63.2 (9.47) years. 79.7% were male; and 87.2% had an ASA grade ≥2. After adjustment for relevant confounders, prolonged interval following CRT was associated with an increased 90-day mortality; compared to 0–50 (reference), 51–100 days (HR=1.54, 95%CI 1.04–2.29), 101–200 days (HR=2.14, 95%CI 1.37–3.35) and >200 days (HR=3.06, 95%CI 1.64–5.69). Similarly, a poorer 5-year survival was also observed with prolonged interval following CRT compared to 0–50 (reference), 101–200 days (HR=1.41, 95%CI 1.17–1.70) and >200 days (HR=1.64, 95%CI 1.24–2.17).

Conclusions

Prolonged interval following CRT and esophagectomy is associated with increased 90-day mortality and poorer long-term survival. Patients must be carefully considered and counselled regarding surveillance and salvage esophagectomy following CRT.
OGC O09 The clinical utilisation of tissue imaging Mass Spectrometry as a diagnostic model for Oesophageal Adenocarcinoma
Authors: Patel Pranav , Kumar Sacheen , Doria Luisa , Soares Renata , Abbassi-Ghadi Nima , Takats Zoltan , Hanna George
Published: December 2022

Background

The prevalence of Oesophageal adenocarcinoma (OA) in the United Kingdom has steadily risen since the 1970's. The majority of patients present with advanced disease. Early diagnosis utilising point of care testing may enable an increase in the number of patients managed on a potentially curative pathway. Tissue Imaging Mass Spectrometry by Desorption Electrospray (DESI-MS) is one such tool to differentiate the abundance of lipids in OA. This work presents the novel use of Mass Spectrometry (MS) imaging to identify variations in lipid abundance between OA and normal oesophagus (NO).

Methods

Tissue was sampled from specimens dissected immediately post-resection from the tumour and at 5-centimetre intervals in the proximal NO. Forty-one unique patient OA and NO tissue samples were analysed in triplicate by DESI-MS tissue imaging to differentiate Glycerophospholipids. A total of 246 DESI-MS images were correlated with paired formalin fixed Haematoxylin and Eosin stained tissue slides, the current gold standard cancer diagnostic test. Principle component analysis utilising a supervised model classified tissue types with a significance of p=0.01. Receiver operator curves (ROC) were used to determine the diagnostic sensitivity and specificity of DESI-MS for the identification of adenocarcinoma.

Results

Tissue analysis confirmed unsaturated Phosphatidylglycerols and Phosphatidic acids were significantly more abundant in OA compared to NO (p<0.001). Tissue analysis by a Partial Least Square (PLS) supervised linear regression model classified cancer and non-cancer tissue with a confusion matrix classification of 93.3% and 70.8% for OA and NO (Figure 1a-c). A diagnostic sensitivity of 85% and specificity of 88% was determined by ROC curve. The abundance of Phosphatidylglycerol and Phosphatidylserine decreased proportionally in analysed tissue sections at 5cm and 10cm from the primary tumour, as did the degree of lipid unsaturation.

Conclusions

This work presents a novel tissue imaging MS model to differentiate lipid abundance in OA. An abundance ratio of 1.17:1 (OA:NO) of unsaturated Phosphatidylglycerol was diagnostic of cancer by DESI-MS with a high sensitivity and specificity. This MS tissue analysis model has the potential to enable accurate point of care diagnostics for OA. In addition, we suggest oesophageal cancer induced perturbation of Glycerophospholipid metabolism may be a potential target for future chemotherapeutics.
BS P02 Sleeve gastrectomy and gastric bypass day surgery: outcomes and experience from a single centre
Authors: Katz-Summercorn Annalise , Shah Runil , Arhi Chanpreet , Musendeki Debbie , Fitt Irene , McGrandles Rosie , Zalin Anjali , Rashid Farhan , Adil Md Tanveer , Jain Vigyan , Mamidanna Ravikrishna , Jambulingam Periyathambi , Munasinghe Aruna , Whitelaw Douglas , Al-Taan Omer
Published: December 2022

Background

Internationally, day case Bariatric surgery has been shown to be safe, feasible and economically beneficial. However, it has not been widely adopted in the UK. It requires careful patient selection and a mature enhanced recovery programme. We report on the outcomes and lessons learned during our 2.5-year experience of day case laparoscopic sleeve gastrectomies (LSG) and Roux-en-y gastric bypass (RYGB) operations.

Methods

A retrospective analysis was performed of all patients who were selected as candidates for day case Bariatric surgery in a single-centre since October 2019. Patients were considered eligible if they had a BMI <60, lived within 30 minutes of the hospital, were having primary surgery with no additional procedure and were not on CPAP. All patients received a nurse-led telephone assessment on day 1. Rates of successful discharge, patient demographics, readmission and outcomes were analysed.

Results

Thirty-nine patients were identified as suitable candidates for day case operations: 24 (62%) RYGB, 15 (38%) LSG. The mean BMI was 46.5; 85% female. The main reason for not being considered was the patient living >30 minutes away. Overall, 18 (13 RYGB, 5 LSG; 46.2%) were successfully discharged on the day of surgery. Fifteen (38.5%) were discharged on the first post-operative day and 6 (15.4%) stayed two or more days. The commonest reasons for failed discharge were nausea/vomiting 6 (15.4%) and logistical issues e.g. operation in the afternoon 6 (15.4%). There was one readmission within 30 days (sealed leak from the gastro-jejunal anastomosis) but no returns to theatre.

Conclusions

We have successfully performed day case Bariatric surgery in our centre. However, it is a logistical challenge and to date has only been carried out successfully on a small number of patients. The main challenge being the vast catchment area for our tertiary centre. Further work is needed to better define the parameters for patient eligibility in order to safely offer this to more patients.
OGBN P05 Is there still a role for routine histology in cholecystectomies for benign disease?
Authors: Hamid Mohammed , Kershaw Marie , Bhakthavalsalan Resya , Shivamurthy Rishika , Davies Sian , Ahmed Zuhair
Published: December 2022

Background

A movement towards selective histology for benign gallbladder disease is evolving in the United Kingdom (UK). Studies propose the reliance on macroscopic features to identify incidental gallbladder cancer (IGBC). We aimed to investigate the rate of dysplastic gallbladder histology, the rate of subtotal cholecystectomy and identify any selection criteria for selective histology.

Methods

A retrospective observational study examining patients who underwent a cholecystectomy, amid the COVID-19 pandemic, between January 2020 and June 2021. This study was carried out in a large Trust in the West Midlands, UK. Multivariate logistical regression models were used to identify patient factors associated with IGBC and compare outcomes between total and subtotal cholecystectomy.

Results

There were 959 patients; 631 (65.8%) elective and 328 (34.2%) emergency cholecystectomies. Median age was 48 (35–59) years, and 724 (75.5%) patients were female. 27 (2.8%) patients had a subtotal cholecystectomy with worse post-operative complications (Clavien-Dindo grade 3+, OR 4.69, p=0.026), however no patient suffered a common bile duct injury. Eight (0.8%) patients had IGBC of which 6/8 were diagnosed as cholelithiasis on ultrasound. Five IGBCs had no macroscopic features. One patient needed further surgery and chemotherapy. Gallbladder polyps on ultrasound was the only patient factor associated with increased likelihood of IGBC (OR 14.49, p=0.014).

Conclusions

We support the current recommendation of the UK Royal College of Pathologists to routinely examine all cholecystectomies removed for benign disease, given that macroscopic features may be absent in IGBC and no clear patient factors to support a selective approach.
EGS P08 Endoscopic ultrasound-guided transmural gallbladder drainage – Who can benefit?
Authors: Boreham Zoe , Taylor Luke , Al-Khafaji Nadeem , Abbadi Reyad , Alexandridis Efstratios , Brown Oliver , Byrne Benjamin , Karteszi Hedvig , Skipworth James , van Laarhoven Stijn
Published: December 2022

Background

Endoscopic ultrasound-guided gallbladder drainage (EGBD, cholecysto-duodenostomy) is a safe alternative to percutaneous gallbladder drainage (PGBD) for treatment of acute cholecystitis, and avoids morbidity from external drains. However it may complicate attempts at future cholecystectomy. We aimed to identify a patient subgroup that would not be fit for surgery in the future and therefore should be considered for EGBD.

Methods

Patients with cholecystitis were identified retrospectively using hospital coding (2012–2022). Additional codes for cholecystectomy and percutaneous drainage were used to identify subgroups. Patient characteristics were also collected. Charleston comorbidity index (CCI) and APACHEII score were calculated where data were available. Statistical analyses were performed in R (Welch t-test). Data are displayed (mean LC vs mean NLC, p value).

Results

5653 patients with cholecystitis were identified (3765 LC, 66.6%). 53(0.94%) underwent PGBD. 23(43%) subsequently underwent LC. Patients in the LC group were younger (62.2vs74 p=0.002) and had a lower CCI (3.6vs5.9 p=0.001) compared to the non-operative (NLC) group. APACHE scores were calculated in 40/53 patients (16 LC, 24 NLC) and were similar between groups (8.5vs10.6 p=0.76). BMI was calculated in 41 patients (18 LC, 23 NLC) and was not significantly different (30.0vs30.6 p=0.19).

Conclusions

We have identified an older, more comorbid subgroup of patients with severe cholecystitis who are unlikely to be fit for surgery and could potentially benefit from definitive EGBD. There remains a place for PGBD in patients that will eventually become suitable for LC.
EGS P28 Transhiatal oesophagectomy to salvage transacted oesophagus from laparoscopic paraoesophageal hernia repair
Authors: (Linda) Lin Yi-Tzu , Almonib Ahmed , Tan Benjamin
Published: December 2022

Background

Perforation of oesophagus and stomach during paraoesophageal hernia (POH) repair can be caused by traction on the lower oesophagus, gastro-oesophageal junction (GOJ) and fundus, or a thermal injury from the energy device during dissection. Iatrogenic complete transaction of oesophagus during elective laparoscopic POH repair is extremely rare. Here we reported this unusual complication.

Methods

A 79-year-old man with a history of hypertension and hypothyroidism underwent elective laparoscopic POH repair in a district hospital. During the surgery, oesophagus was transacted above the level of GOJ due to constant traction on the lower oesophagus and GOJ. Patient remained haemodynamically stable and was transferred to our tertiary centre next day.

Patient was taken to theatre for midline laparotomy. Intraoperatively, stomach, omentum and transverse colon were in the chest and reduced carefully. The oesophageal stump, approximately 20cm from hiatus, was found in the mediastinum with the use of a nasogastric tube. It was also noted that there were several serosal tears on the proximal stomach and left gastric vessels were already divided. Unfortunately, oesophageal stump was ischaemic and friable. Therefore we decided to perform transhiatal oesophagectomy. Oesophagus was fully mobilised via cervical and abdominal incisions and was resected above the level of clavicle. Cervical oesophagogastric anastomosis was performed with semi-mechanical end-to-side EndoGIA 30mm blue and interrupted 3-0 PDS. Postoperatively, he was transferred to intensive care unit for ongoing care.

Results

Patient was off inotropes of Day 2 and extubated on Day 3 postoperatively. He developed pneumonia and atrial fibrillation and was treated with intravenous antibiotics and amiodarone. He has recovered well and is currently awaiting transfer to the ward.

Conclusions

Complete transection of oesophagus due to of traction in laparoscopic POH is an extremely uncommon complication. Transhiatal oesophagectomy can be considered as a management option in selected cases.
HPB P15 A retrospective cohort study investigating the progression of sarcopenia and its impact on outcomes in patients with pancreatic cancer undergoing neoadjuvant chemotherapy
Authors: Anand Jyotsna , Pande Rupaly , Choudhary Surabhi , Roberts Keith
Published: December 2022

Background

Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease, with surgical resection providing the best chance of survival. However, many patients are not eligible for surgery. Neoadjuvant therapy (NAT) offers the potential to downsize the disease to enable resection for patients with borderline resectable (BR) or locally advanced (LA) PDAC. This study aims to assess changes in body composition during NAT, in particular, the progression of sarcopenia, and how this impacts outcomes in these patients.

Methods

This is a retrospective cohort study including 65 patients with BR or LA-PDAC who underwent NAT between January 2017 and December 2020. Routine baseline and post-NAT computed tomography scans were analysed for changes in sarcopenia and adiposity measurements. The impact of these changes on chance of resection and overall survival was assessed. Additionally, the effect of pancreatic enzyme replacement therapy (PERT) on these changes and outcomes was investigated.

Results

Muscle mass and adiposity decreased during NAT (p<0.05). 42% received resection following NAT. Those who were still not eligible for resection experienced greater reductions in muscle mass (-0.84cm2/m2 vs - 0.36cm2/m2, p=0.005) and subcutaneous adipose (-43.3cm2 vs -19.7cm2, p=0.033). Changes in body composition were not independently associated with overall survival. Patients receiving PERT experienced less reduction in muscle mass (-0.41cm2/m2 vs -0.82cm2/m2, p=0.0009).

Conclusions

This study suggests that there is progression of sarcopenia and a reduction in adiposity during NAT, which could preclude surgical resection of PDAC. PERT may reduce the progression of sarcopenia. Larger studies in this field are required to draw reliable conclusions.
HPB P37 Outcomes following EUS choledocho-duodenostomy for the palliative treatment of peri-ampullary cancer following unsuccessful ERCP – A single centre experience
Authors: Kourdouli Amar , Barrie Jenifer , Cameron Ian , James Martin , Sanyal Sudip , Venkatachalapathy Suresh
Published: December 2022

Background

EUS-guided choledocho-duodenostomy is an option to relieve jaundice after a failed ERCP, in patients with locally advanced or metastatic peri-ampullary cancers. We aim to assess the technical success, safety and outcomes of the procedure in our practice.

Methods

All consecutive adult patients that underwent EUS-guided CBD stent placement after a failed ERCP between December 2019 and May 2022 at the Queens Medical Centre, Nottingham were included. Studied variables included demographics, technical characteristics and outcomes including length of stay, normalisation of bilirubin level, complication rate and 30-day mortality rate.

Results

Twenty-six consecutive patients were included in this study (12 males, 14 females). The mean age was 75 (range 52–92) years. Pancreatic cancer was present in 15 patients (57.6%), 4 patients (15.3%) each had ampullary cancer and other malignant peri-ampullary lesions while 3 patients (11.5%) had duodenal cancer. Metastatic disease was present in 13 patients (50%). Mean ECOG status was 2 (n= 13). ERCP was unsuccessful due to an inability to cannulate the CBD (n= 3), duodenal tumour infiltration (n=10), destroyed ampulla (n=6) and inaccessible papilla (n=5).

EUS-guided CBD stent placement was successful in 24 patients (92.3%). The mean CBD diameter at presentation was 19.5 mm (range 14–32) and mean distance between the bile duct and duodenum was 4.2 mm.

The complication rate was 15.3% (4/26 patients). Complications included cholecystitis, stent blockage, slow bleeding and bowel perforation after a displaced stent. Median post-procedure LOS was 5.5 days. A reduction in bilirubin to <50% was observed in 19 patients (73%) by discharge. There were 2 biliary re-interventions in the group. The overall 30-day mortality rate was 38.4% (n=10) with a procedure specific mortality of 11.5% (n=3).

Conclusions

EUS-guided choledocho-duodenostomy is an effective and safe option to relieve jaundice in this group of patients.
HPB P42 Investigating Factors Associated with Favourable Pathological Tumour Regression After Neoadjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma
Authors: Halle-Smith James , Leung Prudence , Roberts Keith
Published: December 2022

Background

Neoadjuvant chemotherapy (NAT) is increasingly used in the management of pancreatic ductal adenocarcinoma (PDAC). Pathological response of the tumour to NAT can be assessed using grading systems such as the College of American Pathologists (CAP) system, with favourable regression being associated with improved survival. The aim of the study was to investigate factors associated with favourable tumour regression in patients undergoing pancreatoduodenectomy (PD) for PDAC

Methods

Patients who received NAT before undergoing PDAC resection at our institution between 2012 and 2020 were reviewed. Interactions between chemotherapy, tumour staging, carbohydrate antigen 19–9 (Ca19–9) levels, perioperative factors and pathological tumour regression grading (TRG) were explored.

Results

27 patients were suitable for inclusion with a median follow-up of 17.9 months. 7 (26%) patients had a favourable response to NAT. Demographic details and initial tumour staging was similar between the groups. There was a significant difference in the change in Ca19–9 levels from the start of NAT to the end of NAT between the favourable and non-favourable TRG groups, with a significantly greater reduction in Ca19–9 observed in the favourable TRG group [median -1,862 U/mL (IQR: -7,028 U/mL to -121U/mL)] compared to the unfavourable TRG group [median -194 U/mL (-635 U/mL to -3.9 U/mL); p=0.011). There was no significant difference in the chemotherapy regime, number of cycles or number of patients who had a dose reduction due to adverse effects. The time from diagnosis to chemotherapy and time from end of chemotherapy to surgery were also similar.

Conclusions

In this small retrospective study, a greater reduction in Ca19–9 was significantly associated with a favourable TRG, which has been associated with improved survival. Patient numbers are limited due to the recent introduction of regression grading to pathology reporting guidelines so multicentre collaboration should be encouraged to identify more factors associated with favourable tumour regression. Translational research may also be able to identify other factors (e.g. gene expression) which are associated with favourable tumour regression.
HPB P51 The impact of the SARS-CoV-2 pandemic upon pancreatic cancer treatment (CONTACT Study): a UK national observational cohort study
Authors: Hall Lewis , McKay Siobhan , Halle-Smith James , Soane Joshua , Osei-Bordom Daniel , Magill Laura , Pinkney Thomas , Radhakrishna Ganesh , Valle Juan , Corrie Pippa , Roberts Keith
Published: December 2022

Background

The SARS-CoV-2 pandemic has had an unprecedented impact on healthcare systems, and cancer patients were amongst the most vulnerable. CONTACT is a national multidisciplinary study assessing the impact of the SARS-CoV-2 pandemic upon diagnostic and treatment pathways among patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

A novel, mixed prospective and retrospective design, with retrospective case identification of both cohorts, and trainee-performed data collection. The treatment of consecutive patients with newly diagnosed PDAC from a pre-COVID cohort (07/01/2019–03/03/2019) were compared to a cohort diagnosed during the first wave of SARS-CoV-2 in the UK (‘COVID’ cohort, 16/03/2020–10/05/2020), with 12-month follow-up.

Results

Among 984 patients (pre-COVID: n=483, COVID: n=501), across 96 hospitals, the COVID cohort were less likely to receive staging investigations other than CT scan (148/501, 29.5% vs 180/486, 37.2%; p=0.01). Among patients treated with curative intent, there was a reduction in the proportion of patients recommended surgery (42/77, 54.5% vs 72/94, 76.6%, p=0.001) and increase in the proportion recommended neoadjuvant therapy (35/77, 45.5% vs 22/94, 23.4%, p=0.002). Among patients within a non-curative pathway, fewer patients were recommended (201/424, 47.4% vs 223/389, 57.3%, p=0.004) or received palliative therapy (87/424, 20.5% vs 103/389, 26.5%, p=0.045). Ultimately, fewer patients in the COVID cohort underwent resection surgery (29/501, 6.4% vs 45/483, 9.3%, OR 0.64, 95%CI: 0.37–0.97, p=0.036), whilst more patients received no treatment whatsoever (347/501, 69.3% vs 286/483, 59.2% p=0.009). There was no difference in median survival between the COVID and pre-COVID cohorts, (105 days, IQR: 86–124 vs 130 days, IQR: 108–157, p=0.093).

Conclusions

The CONTACT study confirms alarming reduction in the staging and treatment provided to patients with PDAC diagnosed during the SARS-CoV-2 pandemic. Restoration of cancer services to pre-pandemic standards must be urgently addressed.
HPB P65 Resection margin status and five-year survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma
Authors: Russell Thomas , Labib Peter , Aroori Somaiah
Published: December 2022

Background

Fit patients with a resectable cancer affecting the pancreatic head may be offered pancreatoduodenectomy (PD). Although this remains the only curative intent treatment option, few patients achieve long-term survival as early disease recurrence is common. This study aimed to investigate the correlation between resection margin status and five-year survival in PD patients whose postoperative histology confirmed pancreatic ductal adenocarcinoma (PDAC).

Methods

Data was extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1,484). Patients with postoperative histology suggestive of PDAC were identified and compared to one another by their resection margin status. Five-year survival rates were compared using Fisher's exact test.

Results

A total of 885 patients had PDAC (59.6%) and 798 of these (90.2%) had resection margin data available. Of these, 393 (49.2%) had no positive margins (R0), 403 (50.5%) had at least one positive resection margin (R1), and 27 (3.4%) had an incomplete resection where tumour was knowingly left in situ at the time of surgery (R2). Five-year survival was 30.0%, 16.9% and 14.8% in those with R0, R1 and R2 disease, respectively. Patients with R0 disease had significantly higher five-year survival compared to those with R1-2 disease (30.0% vs 16.7%, p<0.00001).

Conclusions

In our multicentre international study of PD patients, almost half of all those with PDAC had no positive resection margins. Whilst these patients had improved outcomes compared to those with at least one positive margin, less than a third achieved five-year survival.
HPB P69 Minimally invasive versus open management of chronic pancreatitis - A systematic review
Authors: Kourdouli Amar , Garceae Giuseppe
Published: December 2022

Background

Surgical treatment for chronic pancreatitis (CP) is usually performed via an open approach through drainage (pancreaticojejunostomy) or resection (pancreaticoduodenectomy, Beger) procedures or a combination of both (Frey's procedure). Minimally invasive (laparoscopic, robotic) management for patients with CP represents a technical challenge. The aim of this systematic review is to report the outcomes of these minimally invasive procedures among themselves and compare them with reported data from the literature for open procedures.

Methods

A systematic literature search using Embase and Medline was performed to identify articles reporting CP.

Results

Twelve studies with 186 patients undergoing a laparoscopic procedure for their intractable abdominal pain caused by their CP. Sixty-six-point six percent of patients (n=124) underwent a laparoscopic drainage procedure while 33.3% (n=62) had a partial or total resection of their pancreas. Total pain relief was achieved in 66.7–100% following laparoscopic pancreatojejunostomy, 93% following laparoscopic Frey's procedure, 90% following laparoscopic total pancreatectomy and islet transplantation and 70% following laparoscopic distal pancreatectomy.

Conclusions

Laparoscopic procedures for CP are safe and feasible for a carefully selected group of patients. However, more robust comparisons are required between laparoscopic and open approaches in the form of multi-centre randomised controlled trials.
OGC P11 Recurrent laryngeal nerve injury after oesophagectomy: incidence, management and clinical sequelae
Authors: Chien Siobhan , Gall Lewis , Khan Khurram , Craig Carol , MacKay Colin , Macdonald Andrew , Forshaw Matthew
Published: December 2022

Background

Recurrent laryngeal nerve palsy (RLNP) resulting from injury during the cervical-stage of oesophagectomy is a recognised complication that can be associated with significant morbidity. This study aimed to investigate the incidence of RLNP within our local practice, to describe its management, short- and long-term sequelae.

Methods

Consecutive patients undergoing transhiatal oesophagectomy or 3-stage oesophagectomy with cervical anastomosis for both benign and malignant disease within a single UK regional centre between 1 January 2010 and 31 December 2019 were included from a prospectively collected database. Electronic records were interrogated and patients dichotomised into two groups – postoperative RLNP (paresis or paralysis) compared to no RLNP.

Results

182 patients were eligible for analysis. 33 patients (18.1%) developed RLNP after oesophagectomy. Patients with RLNP were significantly more likely to develop postoperative pneumonia (57.6% vs. 34.2%; p=0.017) and ARDS (9.1% vs. 0.7%; p=0.019), and were more likely to require ICU admission (30.3% vs. 14.8%; p=0.044). They were also found to have a longer length of hospital stay (24 vs. 15 days; p=0.001). 18 patients (54.5%) with RLNP required ENT review with 3 patients (9.1%) requiring vocal cord collagen injection. After a median 34 months (IQR 21.75-67) follow-up, 36.4% (12/33) patients had made a full and 42.4% (14/33) patients had made a partial recovery.

Conclusions

Judicious surgical technique in an attempt to avoid initial RLN injury, as well as proactive involvement of SALT and ENT specialists when injury does occur, are vital to reduce the significant pulmonary morbidity associated with this common complication of oesophagectomy.
OGC P25 Outcomes of Laparoscopic Vs Open Oesophagectomy in a single high volume centre
Authors: Hossain Tanvir , Jackson Andrew , Youssef Fady , Trotter Martin , Yanni Fady , Zanotti Daniela , Catton James , Welch Neil , Vohra Ravi , Parsons Simon L
Published: December 2022

Background

Oesophageal cancer has a poor 5 year survival and surgery is the mainstay of curative treatment for the majority of cases. Minimally invasive surgery is practiced in a number of formats (open thorax/open abdomen, open thorax/lap abdomen, thoracoscopic/lap abdomen) and its benefits have been subject to a number of trials.

Methods

We interrogated a prospectively recorded database of oesophagogastric cancer surgery from a large single centre to compare oesophagectomy cases performed with curative intent comparing laparoscopic abdomen plus open thorax versus a totally open operation. Transhiatal oesophagectomies were excluded. Baseline data was compared to establish whether groups were equally matched and outcomes of length of stay, any complication, anastomotic leak, number of lymph nodes yielded, 30 day mortality and 90 day mortality were subject to statistical analysis. Missing data was not imputed.

Results

Sixty-nine hybrid oesophagectomies (laparoscopic abdomen, open thoracic phase) and 373 totally open procedures were performed between January 2017-May 2022. Both groups were equally matched in terms of age, performance status, ASA, tumour site, gender ratio and histology. LOS was 11.6 vs 13.5 (lap vs open / days), P=0.72. Complication rate was 33.3% v 37.3% (lap vs open) P= 0.53. Anastomotic leak rate was 10.1% vs 8.9% (lap vs open) P=0.73. Number of lymph nodes yielded was 25.8 ± 2.17 vs 24 ± 0.59 (lap vs open, mean ± s.e). Thirty day mortality was 2.9% vs 2.17% (lap vs open) P=0.66. Ninety day mortality was 7.25% vs 4.19% (lap vs open) P=0.27.

Conclusions

This 5 year dataset of equally matched laparoscopic abdominal phase vs totally open oesophagectomy procedures shows no statistically significant difference in the outcomes that were measured. The laparoscopic approach would be expected to inflict a lesser stress response than open surgery. Oesophagectomy along with possible complications may inflict a stress response that masks the benefits from laparoscopic surgery. This data supports the notion that the laparoscopic abdomen approach is not inferior to an open procedure. Interrogation of a larger 10 year dataset would be worthwhile to confirm this. Furthermore, this current study may be merely be reflective of the learning curve for the laparoscopic approach and a prospective study of our practice will be worthwhile.
OGC P32 Prognostic impact of clinicopathological features following metastectomy for metachronous pulmonary metastasis from oesophageal cancer: a systematic review and meta-analysis
Authors: Prasad Pooja , Nevins Edward J , Brown Joshua , Phillips Alexander W
Published: December 2022

Background

Disease recurrence following treatment for oesophageal cancer (OC) remains common despite incremental gains from receipt of neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive OC treatment. Clinicopathological features of the primary oesophageal tumour have implications on the development of metastatic disease and overall survival. This systematic review sought to identify the prognostic impact of clinicopathological features of the primary oesophageal tumour following treatment of metachronous pulmonary metastasis from OC.

Methods

A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to March 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on the clinical and pathological features of the primary OC tumour among patients undergoing treatment for metachronous pulmonary metastasis were included. A random effects meta-analysis model was used to compare the impact of gender (male vs female), primary OC pathological T-stage (pT1/2 vs pT3/4) and pathological N-stage (N0 vs N1+), on 5-year survival following pulmonary metastectomy.

Results

Seven non-randomised studies comprising 110 patients undergoing pulmonary metastectomy for metastatic OC were included. Gender did not have an impact upon 5-year survival (Risk Ratio (RR) =0.65; 95% confidence interval(CI):0.37–1.15; p=0.14). A lower primary OC T-stage (T1/2) was associated with improved 5-year survival following pulmonary metastectomy compared to advanced T-stages (T3/4), though this did not reach statistical significance (RR= 1.76; 95% CI:0.96–3.20; p=0.07). The absence of nodal disease (N0) in the primary disease did not confer a survival benefit over those patients with nodal involvement (N1+) proceeding to pulmonary metastectomy (RR= 1.45; 95% CI:0.86–2.46; p=0.18).

Conclusions

Patient gender and pathological T- and N-stages of the primary tumour do not impact upon prognosis following metastectomy for metachronous pulmonary metastasis from OC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the treatment of the primary oesophageal tumour, limiting outcome assessment.
OGC P43 Oncological outcomes following the introduction of laparoscopic gastric mobilisation during Ivor Lewis Oesophagogastrectomy within a regional Scottish centre
Authors: Smith Lucy , Khan Khurram , MacKay Colin , Craig Carol , Forshaw Matthew , Macdonald Andrew , Gall Lewis
Published: December 2022

Background

Ivor Lewis Oesophagogastrectomy (ILO) is a potentially curative but highly morbid surgery. Minimally invasive techniques by comparison have demonstrated improved post-operative outcomes for patients. Hybrid laparoscopic gastric mobilisation (LGM) combined with an open right thoracotomy was introduced in our centre in 2019. This study assessed oncological outcomes between ILO with LGM and a fully open ILO, following this local change in operative technique.

Methods

This was a retrospective study of patients undergoing ILO at a single tertiary unit over a 5-year period (2017–2021). All patients undergoing open ILO were compared with those who had ILO with LGM. Resected lymph node count was used as a marker for oncological outcomes and median length of hospital stay a marker for post-operative outcomes.

Results

During the study period, 42 patients had open ILO and 32 had ILO with LGM. Patient demographics were similar between groups, with the majority receiving neoadjuvant chemotherapy (Open ILO 92.9% vs LGM 96.9%, p=0.629). Following local introduction of LGM in 2019, it immediately became the predominant method of gastric mobilisation during ILO (58% cases in 2019; 100% cases in 2020; 73% cases in 2021). Median total lymph node count resected was similar between LGM 17(15–25) vs open ILO 18 (16–24), p=0.643. Overall, length of stay was shorter in those having LGM compared to open (16 (11–21) vs 18 (11–36)), although this did not reach statistical significance (p=0.129).

Conclusions

Introduction of a hybrid minimally invasive technique for oesophagogastrectomy within our regional centre, has been associated with similar oncological outcomes to the traditional open approach. Further evaluation is required to ascertain the potential patient benefits of a LGM on post-operative outcomes within our patient cohort.
OGC P47 The Role of Endoscopic Ultrasound Scan In Staging Patients With Oesophageal Cancer- A Retrospective Single Centre Study
Authors: Ammar Ahmed , Anis Fady , Fabelurin Christiana , Herbert Saul , Awad Sherif , Leeder Paul , Iftikhar Syed , El-Sharkawy Ahmed
Published: December 2022

Background

There are conflicting opinions on the role of Endoscopic Ultrasound (EUS) in the staging of oesophageal cancer (OG) patients which can complicate and delay intervention. We aim to audit the use of EUS in the OG cancer staging pathway as well as assess accuracy in selected cases.

Methods

A retrospective audit of the hospital database of patients diagnosed with oesophageal carcinoma between January 2016 and March 2021.The duration between the first MDT and EUS performed was calculated. Concordance between initial CT and EUS stage as well as histology in patients that were offered direct to surgery were evaluated using Cohen's Weighted Kappa.

Results

A total of 301 patients were identified. Overall, there was a moderate agreement (K=0.526) between CT and EUS reported T Staging(p<0.001). There was substantial agreement (K=0.798) between CT reporting T2, T3 and EUS(p<0.0005). Twenty-seven patients underwent upfront surgery-11 were T1, 16 were T2 and T3 disease. Comparing to final histology, EUS reported an accurate T1 stage in 36.3% compared with 0% with CT (p=0.018), whereas T2 and T3 disease were accurately reported with EUS and CT in 43.7% and 37.5% respectively (p=0.375). The median number of days between first MDT and EUS was 14 days (8,18) and this was requested after CT and PET CT results were available in 80% of cases.

Conclusions

This audit demonstrates minor differences between EUS and CT for T2 and T3 disease and therefore unlikely to alter management. However, EUS is superior to CT for staging Tx and T1 disease and is therefore likely to impact on the treatment options. EUS also contributed to prolonged pre-treatment staging time. Adopting a selective approach to EUS could result in overall reduction of waiting times from referral to decision making and increase cost-effectiveness.
Negative Social Interactions at the Intersection of Gender, Race and Immigration Status in Canada
Authors: Chuang Deng-Min , Leung Vivian W Y , Lung Yu , Fang Lin
Published: December 2022

Negative social interactions (NSIs), defined as upsetting interpersonal encounters in daily life, are associated with adverse mental health conditions. Guided by an intersectional perspective, this study explored the impacts of gender, race and immigration status on the experiences of NSIs, using nationally representative data from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). The sample consisted of 21,932 participants across Canada. Gender-specific multivariable logistic regression models were used to estimate the effects of race, immigrant status and the interaction term on the likelihood to experience NSIs. Study results showed that women (32.3 per cent) reported significantly more NSIs than men (25.4 per cent). For men, being an immigrant was significantly associated with a lower likelihood of experiencing NSIs; race did not have a significant effect on NSIs. Furthermore, the results revealed that racialised Canadian-born women were more likely to report NSIs than racialised immigrant women, whilst immigration status had no effect among white women. This study suggests the distinct influences of intersecting identities of race, gender and immigration status and that social workers should incorporate an intersectional lens when exploring clients’ social relationships and environments.
Establishing ground truth in the traumatic brain injury literature: if replication is the answer, then what are the questions?
Authors: Priestley Diana R , Staph Jason , Koneru Sai D , Rajtmajer Sarah M , Cwiek Andrew , Vervoordt Samantha , Hillary Frank G
Published: December 2022

The replication crisis poses important challenges to modern science. Central to this challenge is re-establishing ground truths or the most fundamental theories that serve as the bedrock to a scientific community. However, the goal to identify hypotheses with the greatest support is non-trivial given the unprecedented rate of scientific publishing. In this era of high-volume science, the goal of this study is to sample from one research community within clinical neuroscience (traumatic brain injury) and track major trends that have shaped this literature over the past 50 years. To do so, we first conduct a decade-wise (1980–2019) network analysis to examine the scientific communities that shape this literature. To establish the robustness of our findings, we utilized searches from separate search engines (Web of Science; Semantic Scholar). As a second goal, we sought to determine the most highly cited hypotheses influencing the literature in each decade. In a third goal, we then searched for any papers referring to ‘replication’ or efforts to reproduce findings within our >50 000 paper dataset. From this search, 550 papers were analysed to determine the frequency and nature of formal replication studies over time. Finally, to maximize transparency, we provide a detailed procedure for the creation and analysis of our dataset, including a discussion of each of our major decision points, to facilitate similar efforts in other areas of neuroscience. We found that the unparalleled rate of scientific publishing within the brain injury literature combined with the scarcity of clear hypotheses in individual publications is a challenge to both evaluating accepted findings and determining paths forward to accelerate science. Additionally, while the conversation about reproducibility has increased over the past decade, the rate of published replication studies continues to be a negligible proportion of the research. Meta-science and computational methods offer the critical opportunity to assess the state of the science and illuminate pathways forward, but ultimately there is structural change needed in the brain injury literature and perhaps others.
Ethics for educational research in regions of protracted armed conflict and crisis: a participatory community project in the Lake Chad region
Authors: Ebubedike Margaret , Akanji Tajudeen , Kunock Afu Isaiah , Fox Alison
Published: December 2022

This paper critically considers the ethics of conducting community-based participatory research, which engages community members, including young people, as active participants in research about them, in the context of the protracted armed conflict and crisis of the Lake Chad region. We highlight the intersection of cultural practices and religious belief systems prevalent in this context, which further deepens the complexities arising from researching populations experiencing protracted armed conflict and crisis. This raises the possibilities of understanding research ethics in such contexts via the lens of a postcolonial frame. Using participatory photography allowed engagement in face-to-face collaborative data collection. In doing so, the research team was able to pay attention to verbal and non-verbal dimensions arising from community engagement, which supported learning about the community’s positions and needs as a resource for thinking about how these might need accommodation in the project. It is not straightforward to lead this kind of project as researchers based in the Global North in terms of deciding what is right and what research practices would be considered just, compassionate, and trustworthy in these contexts. The approach taken was to distribute leadership in the project to include local actors such as NGOs working at local levels, community leaders (traditional and religious), as well as to draw on in-country research teams and the members of each of the participating communities. We argue that a more nuanced understanding about how to mitigate identified ethical concerns has implications for enhancing community-based research, especially when researching similar populations.
Cortex2vector: anatomical embedding of cortical folding patterns
Authors: Zhang Lu , Zhao Lin , Liu David , Wu Zihao , Wang Xianqiao , Liu Tianming , Zhu Dajiang
Published: December 2022

Current brain mapping methods highly depend on the regularity, or commonality, of anatomical structure, by forcing the same atlas to be matched to different brains. As a result, individualized structural information can be overlooked. Recently, we conceptualized a new type of cortical folding pattern called the 3-hinge gyrus (3HG), which is defined as the conjunction of gyri coming from three directions. Many studies have confirmed that 3HGs are not only widely existing on different brains, but also possess both common and individual patterns. In this work, we put further effort, based on the identified 3HGs, to establish the correspondences of individual 3HGs. We developed a learning-based embedding framework to encode individual cortical folding patterns into a group of anatomically meaningful embedding vectors (cortex2vector). Each 3HG can be represented as a combination of these embedding vectors via a set of individual specific combining coefficients. In this way, the regularity of folding pattern is encoded into the embedding vectors, while the individual variations are preserved by the multi-hop combination coefficients. Results show that the learned embeddings can simultaneously encode the commonality and individuality of cortical folding patterns, as well as robustly infer the complicated many-to-many anatomical correspondences among different brains.
Simultaneous Determination of Phenylethanoid Glycosides and Antioxidant Activity of Syringa pubescens Turcz. from Different Geographical Origin in China
Authors: Yang Qinyu , Wang Xinsheng , Zhang Yanlong , Li Mengyuan , Wang Panxu , Zhang Jiameng , Liu Kun , Wu Yanfang , Shen Guomin , Ma Zhanqiang
Published: December 2022

A high-performance liquid chromatograph with diode array detector was established for the simultaneous determination of five phenylethanoid glycosides in Syringa pubescens Turcz. The optimal chromatographic conditions were achieved on a Zorbax C18 column using gradient elution with 0.5% aqueous acetic acid and acetonitrile as the mobile phase at the flow rate of 1.0 mL/min. The detection wavelength was developed as follows: 0–10 min, 276 nm; 10–45 min, 332 nm. The validation of the method including linearity, precision, stability, accuracy, repeatability and recovery was tested. The chemometric analysis including hierarchical cluster analysis and principal component analysis was employed to investigate the similarity and difference of samples from different geographical origin. The results revealed that S. pubescens samples were divided into four clusters based on the phenylethanoid glycosides contents. Antioxidant activity of extract was measured using three different methods including α,α-diphenyl-β-picrylhydrazyl and 2,2-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid) radical scavenging assays, and ferric reducing antioxidant power assay. Furthermore, different phenylethanoid glycosides exhibited different contribution to antioxidant capacities. This study provides a foundation for the quality evaluation and offers scientific data for the utilization of S. pubescens resources.