bluuebunny/crossref_metadata_2025_split huggingface dataset:
O56: THE TREND OF SURGICAL PUBLICATIONS IN THE UNITED KINGDOM OVER THE LAST 10 YEARS
Authors: Kwan LYA , Chan J 
Published: April 2021

Abstract

Introduction
Research plays an important role in the surgical field. It has been deemed to be the keystone on the progression of surgical care and the introduction of new directions in surgery. We aimed to evaluate the output of UK surgeons in ten high impact factor surgical journals over the last three decades.

Method
Ten surgical journals were selected and investigated, based on 1997,2007, and 2017 journal impact factors. All articles that have contributed academically were examined, these included: original research articles, meta-analysis, debate articles, case reports and studies.

Result
The number of total publications from the ten journals has increased by 35.4% (from 2403 papers in 2007 to 3722 papers in 2017). The number of papers from these journals from the UK has increased by 19.5% (63 papers), however, the percentage output when compared to other regions, has decreased by 2.1% from 10.8% in 2007 to 8.7% in 2017. The USA remains to have the greatest contribution.

Conclusion
The result shows a decline in the percentage output of the UK when compared to other countries. This result aligns with other studies published. Focus should be made on improving the current situation of academic medicine in the UK.

Take-home message
There is a decline in the percentage output of the UK when compared to other countries. Focus should be made on improving the current situation of academic medicine in the UK.
O61: TEXTBOOK SURGICAL OUTCOMES IN OESOPHAGO-GASTRIC CANCER: THE INFLUENCE OF NATIONAL KEY PERFORMANCE INDICATORS
Authors: Al Azzawi M , Bolger JC , Bolger EM , Whooley J , Allen J , Trench L , Downey E , Arumugasamy M , Robb WB 
Published: April 2021

Abstract

Introduction
High quality surgery remains the cornerstone of treating oesophago-gastric malignancy. Recent work from the Dutch Upper-gastrointestinal Cancer Audit (DUCA) have defined ten surgical and perioperative ‘textbook’ parameters that correlate with improved overall survival. The aim of this project was to examine the proportion of patients attaining ‘textbook’ outcomes for oesophagectomy and gastrectomy in our unit before and after the introduction of national key performance indicators (KPIs).

Method
A retrospective review of all oesophagectomies and gastrectomies from January 2010 until June 2019 was performed. Clinical, pathological, perioperative, morbidity and mortality outcomes were recorded. 10 ‘textbook’ parameters were studied pre- and post-KPI introduction.

Result
269 and 284 patients underwent oesophagectomy and gastrectomy respectively, 167 pre-KPI and 386 post-KPI. There were no significant differences in age (67.6 vs 66.4 years, p=0.6), gender (71% male, 29% female vs 68% male, 22% female, p=0.48), ASA grade (p=0.6) or tumour stage (p=0.37) pre- and post-KPI. In the pre-KPI era, 28/167 (17%) patients achieved all ten textbook parameters, compared with 157/386, (41%, p=0.001) post-KPI. This compares favourably to DUCA ‘textbook’ data. There was an improvement in adequate lymphadenectomy (56% vs 83%, p=0.002), a reduction in margin positivity (21% vs 7%, p= 0.001) and peri-operative mortality (6% vs 2%, p=0.03) post-KPI.

Conclusion
There has been a significant improvement in perioperative outcomes in esophagectomy following the introduction of national KPIs in our unit. The number of patients achieving ‘textbook’ outcomes is comparable with international standards. The identification of textbook parameters allows further focus for future quality improvement initiatives.

Take-home message
National KPIs improve peri-operative outcomes in oesophago-gastric cancer.
O68: REDUCING VENOUS CONGESTION FOLLOWING LOWER LIMB RECONSTRUCTION WITH ISOMETRIC CALF EXERCISES: A PROSPECTIVE CLINICAL STUDY
Authors: Geoghegan L , Kwasnicki RM , Henton JM , Hettiaratchy S , Jain A 
Published: April 2021

Abstract

Introduction
Early post-operative dependency aids healing following lower limb reconstruction although increases venostasis and reduces perfusion in the acute setting. The commonest cause of lower limb flap failure is venous congestion and external compression with stockings and pneumatic devices is contraindicated. The aim of this clinical study was to determine whether venous congestion could be reduced through patient-led isometric contractions following lower limb reconstruction.

Method
A single centre prospective clinical study was conducted at St. Marys Hospital, Imperial College NHS Trust. Combined tissue photospectroscopy and laser Doppler (O2C, LEA, Germany) was used to assess superficial oxygen saturation, venous congestion and flow during standardised training regimens. Haemodynamic parameters were collected in an acute post-operative and outpatient rehabilitation cohort.

Result
In the acute post-operative cohort, isometric contractions failed to improve superficial flow following dependency on the post-operative day (POD) one (-44% ± 8). Isometric contractions improved superficial flow from POD5 (+11% ± 102) although venous congestion remained higher than measurements taken during rest (+32% ± 54). In the outpatient rehabilitation cohort isometric contractions significantly increased superficial flow following dependency (+16% ± 33, p=0.01) at a mean of 14 weeks since discharge.

Conclusion
This study provides objective physiological evidence of the haemodynamic changes that occur with dependency and isometric contraction following lower limb reconstruction. These physiological changes evolve following extremity reconstruction and it appears that a continued healing effect exists to accommodate progressive changes in flow dynamics. The present findings could be used to inform enhanced recovery programmes following limb reconstruction.

Take-home message
Simple patient-led calf contractions reduce venous congestion and improve cutaneous flow following lower extremity reconstruction.
O71: INTRA-OPERATIVE SPINAL CORD MONITORING DURING SPINAL SURGERY: DOES IT HAVE ANY CLINICAL VALUE?
Authors: Murphy B , McCabe JP 
Published: April 2021

Abstract

Introduction
Spinal cord surgery is a technically challenging endeavour with potentially devastating complications for patients and surgeons. Spinal cord monitoring (SCM), is one method of preventing and identifying damage to the spinal cord. At present, indications for its use are based more on individual surgeon preference and for medico legal purposes. Our study aimed to determine SCM's utility as a clinical tool.

Method
This is a retrospective case series of 169 patients who underwent spinal surgery with SCM at two institutions between 2013 and 2018. Signal changes detected were recorded as well as the surgeon's response to these changes. Patients were followed up to one-year post-surgery using our institution's EVOLVE system. The main outcome measure in this study was new post-operative neurological signs and/or symptoms and what effect, if any, IONM and subsequent surgeon intervention had on these complications.

Result
Indications for SCM included cervical stenosis, cervical disc prolapse, unstable fractures and bony metastases. Signal changes were observed in 33% (n=55) of cases. 24 of these patients responded to re-positioning. There were 7 total complications with full resolution by 12 months. False negative rate was 2.4% (n=4). There was one true positive. The largest cohort of patients included those who experienced no signal changes and subsequently no post-operative deficits (n=124).

Conclusion
SCM is a non-invasive clinical tool that may be utilised for medicolegal reasons. Its use as a clinical tool is questionable given its relatively high false negative rate and low false positive rate.

Take-home message
Spinal cord monitoring may be used by spinal surgeons for medicolegal reasons if desired. Its use as a clinical tool is questionable at best.
O74: ASSESSING THE USEFULNESS OF THREE-DIMENSIONAL IMAGING AND VIRTUAL REALITY IN SURGICAL PLANNING: A MEDICAL STUDENT LED PILOT STUDY
Authors: Ryan C , O'Malley E , Sheppard D 
Published: April 2021

Abstract

Introduction
Nephron-sparing surgery is becoming more common as surgical techniques advance. VR and 3D visualisation appear to provide better anatomical understanding in presurgical planning than two-dimensional alone. 3D models may enable greater tissue salvation and fewer complications. 3D model preparation and advancing research is expensive and time consuming. We aim to pilot study led by medical student, create reliable anatomical kidney models and assess usefulness in surgical planning.

Method
Routine CT urograms were performed on 128 slice scanner using split bolus technique. Medical student segmented and displayed models in VR using 3DSlicer. Radiology registrar and consultant validated models. Two urology surgeons completed qualitative questionnaires.

Result
We included two patients. Only minor segmentation tweaks by radiologist ensured accurately demonstrated tumors. Tissue contrast quality varied between CT scans complicating segmentation. Both surgeons deemed models helpful in visualising hilar anatomy, predicting bleeding complications, determining laparoscopic/open and partial/full nephrectomy approach. Surgeons prioritised vasculature visualisation over collecting system. Surgeons suggested gauging tumor depth would be useful. Considering 3D printing cost, surgeons agreed VR alone may suffice.

Conclusion
Surgeons found 3D and VR enabled accurate surgical planning and patient counselling regarding nephrectomy risk. Minor CT protocol recommendations enable easier and more accurate segmentation, without increasing patient's radiation exposure. Annual leave during 8-week summer project reflects case numbers. Since, we've identified more cases to assess surgical parameters against matched cohort. We've begun work for adrenal surgery. It's feasible for medical students with minimal surgical/radiological knowledge to advance this research, gaining valuable experience.

Abbrev
Virtual Reality(VR), Three-dimensional(3D), Computerised Tomography(CT)

Take-home message
Three-dimensional imaging and virtual reality may improve surgical planning and patient counselling. Regarding nephrectomy, this could give surgeons the confidence to convert from full nephrectomy to partial nephrectomy approach, improving patient outcome.
O76: SERUM JAM-A AS A PREDICTOR OF TREATMENT RESISTANCE IN BREAST CANCER PATIENTS
Authors: Rutherford EJ , Richards CE , Leech AO , Hill ADK , Hopkins AM 
Published: April 2021

Abstract

Introduction
Junctional Adhesion Molecule-A (JAM-A) has important physiological functions in epithelial and endothelial barriers, but its overexpression has also been linked with tumour progression and poor prognosis in various malignancies. Since JAM-A can be enzymatically cleaved (cJAM-A) and has been detected in the bloodstream, we hypothesized that cJAM-A shed from tumours overexpressing JAM-A may represent a possible predictor of treatment resistance in breast cancer.

Method
An assay was optimised to detect cJAM-A in serum/plasma. Samples were obtained from HER2-positive breast cancer patients (n=20) in Beaumont Hospital. Independently, serial samples were obtained from a Canadian cohort of locally advanced breast cancer (LABC) patients (n=53).

Result
Serum cJAM-A levels in therapy-resistant patients was significantly higher than those in treatment-sensitive patients (p&lt;0.05) in an Irish cohort of HER2 positive patients. In a diverse international cohort of LABC patients, the development of metastatic disease was associated with higher levels of cJAM-A (p&lt;0.05) as well as shorter time to progression (p&lt;0.05).

Conclusion
Our data suggest that cJAM-A merits further investigation as a novel biomarker enabling prospective identification of patients at greatest risk of developing therapeutic resistance.

Take-home message
Our data suggest that cJAM-A merits further investigation as a novel biomarker enabling prospective identification of patients at greatest risk of developing therapeutic resistance.
O79: THE ROLE OF SENTINEL LYMPH NODE BIOPSY IN BREAST CANCER PATIENTS OVER THE AGE OF 80 – HOW MUCH IS ENOUGH?
Authors: Doyle S , Hanley G , Boland MR , Balasubramanian I , McCartan D , Geraghty J , Evoy D , Prichard RS , McDermott EW ,   St. Vincent's University Hospital
Published: April 2021

Abstract

Introduction
Recent studies have suggested that sentinel lymph node biopsy (SLNB) can be omitted in newly diagnosed elderly breast cancer (BC) patients as it may not influence decisions regarding further therapeutic intervention. The aim of this study was to assess the impact of SLNB on further surgical intervention as well as adjuvant treatments in patients over the age of 80.

Method
A retrospective study was performed involving all BC patients over the age of 80 diagnosed between 2008 and 2017 who underwent SLNB as part of their initial surgery. Patient/tumour characteristics and adjuvant treatments were recorded.

Result
127 patients underwent SLNB in the study period. The median age was 82 (Range: 80-95). 91/127 (71.6%) had ductal pathology, median tumour grade was 2, and oestrogen receptor positivity was seen in 89% of patients. The median number of sentinel nodes removed was 2 (Range: 1-6). 45 patients (35.4%) had a positive sentinel node (median positive nodes = 1). Of the 45 patients, 11 proceeded to axillary lymph node dissection (ALND) (11/127; 8.6%). The median number of nodes excised during ALND was 14 (Range:7-25) and 6 patients (6/11) had further positive nodes. 9% of patients with a positive node received adjuvant chemotherapy, 87% received adjuvant radiotherapy and 79% received hormonal therapy.

Conclusion
Although SLNB positivity is still used in the elderly patients, only a few patients (&lt;10%) proceed to ALND or receive adjuvant chemotherapy. Hence performing a SLNB should be carefully considered when treating patients over the age of 80

Take-home message
The use of SLNB in elderly patients needs to be considered in node negative patients
P2: CONSIDERATIONS IN SURGICAL VERSUS NONSURGICAL MANAGEMENT OF HEAD AND NECK MERKEL CELL CARCINOMA
Authors: Crotty T , McHugh A , Griffith P , Moran T 
Published: April 2021

Abstract

Introduction
MCC is a rare cutaneous neuroendocrine tumour with a high risk of regional and distant metastasis. Management of this highly aggressive tumour is complex and mandates a multidisciplinary approach for optimal outcomes.

Method
Over 12 months, three cases of MCC in the cervicofacial region were identified and described. A critical review of the literature is included.

Result
Tumour staging confirmed 2/3 cases had regional spread. One patient underwent unilateral parotidectomy with modified radical neck dissection and adjuvant radiotherapy. The other case is awaiting radiotherapy following a selective neck dissection. The final case had no further surgery and is currently under surveillance.

Conclusion
This case series illustrates the diversity in managing cervicofacial MCC's at various stages of their development.

Take-home message
Merkel cell carcinoma must be managed aggressively with a multidisciplinary approach, regardless of how localised it may appear.
P3: CASE-CONTROL STUDY OF SEXUAL BEHAVIOUR IN HPV-POSITIVE ORAL CAVITY AND OROPHARYNGEAL CANCER
Authors: Crotty T , Brennan S , Cousins G , Kinsella J , Moran T 
Published: April 2021

Abstract

Introduction
HPV infection is recognised as the main aetiological factor responsible for the increased incidence of oropharyngeal squamous cell carcinomas (OPSCC). Currently the epidemiology of oral HPV infection and OPSCC is poorly understood. In this study we aim to define the relationship between sexual behaviours and HPV-positive OPSCC.

Method
We performed a hospital-based, case-control study of 30 patients with HPV-positive and 30 patients with HPV-negative newly diagnosed oral cavity and OPSCC. The participants underwent questionnaire based interviews investigating variables such as age, gender, tobacco use, alcohol intake, and sexual behaviour.

Result
Subjects in the HPV-positive tumour subgroup had significantly less tobacco use then their HPV-negative counterparts (odds ratio, 0.92, 95% CI 0.9-1.17). A history of oral sexual activity was significantly more likely in the HPV-positive tumour subgroup (odds ratio, 5.23, 95% CI, 1.66-16.51), however this association did not remain significant when adjusted for age, gender, smoking and alcohol consumption. Similarly, there was significantly less alcohol consumption overall in the HPV-positive tumour subgroup (odds ratio, 0.107, 95% CI 0.96-1.01), but this association was no longer significant when adjusted for covariables.

Conclusion
Significantly less smoking was prevalent in patients with HPV-positive OPSCC. Although patients with HPV-positive tumours had less alcohol consumption and a stronger history of oral sexual activity overall, greater numbers are required in order to show a significant association. This further supports the known association between HPV-infection and OPSCC and the department of health's decision to commence vaccination of boys before the onset of sexual activity.

Take-home message
HPV-positive oropharyngeal cancer can develop without exposure to established risk factors such as tobacco use or excessive alcohol consumption. This change in pathogenesis should lead a change in how we prevent and manage the disease.
P12: PREDICTORS OF CONVERSION FROM MINIMALLY INVASIVE TO OPEN ADRENALECTOMY: A SYSTEMATIC REVIEW & META-ANALYSIS OF OBSERVATIONAL STUDIES
Authors: Cagney D , O'Leary DP , Razzaq Z , Majeed M , Redmond HP 
Published: April 2021

Abstract

Introduction
Minimally invasive adrenalectomy has become the standard of care internationally in benign adrenal disease. Intra-operative conversion to open surgery is associated with significantly increased morbidity and prolonged hospital stay. The aim of this systematic review is to identify risk factors associated with intra-operative conversion of minimally invasive adrenalectomy.

Method
This systematic review was conducted according to MOOSE guidelines. PubMed, EMBASE and Cochrane library were systematically searched for observational studies evaluating risk factors for intra-operative conversion of minimally invasive adrenalectomy to open surgery. Specific risk factors of interest included patient demographics, patient co-morbidities, tumour characteristics and histology.

Result
Eight studies met the inclusion criteria for analysis with a total of 2939 patients. 6.02% (n=177) required intra-operative conversion. 67.5% (n=1983) underwent laparoscopic transperitoneal adrenalectomy. There were no significant associations between any patient demographics or co-morbidities and intra-operative conversion. Tumour characteristics such as right sided tumours (pooled odds ratio (OR), 1.51; 95% Confidence Interval (CI), 0.98-2.32; p=0.06) and increasing tumour size (OR, 2.29; 95% CI, 1.4-3.74; p=0.001) were shown to be significantly associated with an increased risk of conversion. Pheochromocytoma (OR, 2.21; 95% CI, 1.89-2.58; p&lt;0.0001) and malignancy (OR, 5.38; 95% CI, 2.1-13.81; p=0.005) were also significant predictors of intra-operative conversion.

Conclusion
Minimally invasive adrenalectomy has significantly reduced post-operative morbidity in patients requiring adrenal surgery but the need for intra-operative conversion remains significant. Identifying patients at increased risk of conversion pre-operatively may assist intra-operative decision making and contribute to improved patient outcomes.

Take-home message
Minimally invasive adrenalectomy carries a significant risk of conversion. Recognising patients with known risk factors for conversion aids risk stratification and may contribute to better outcomes.
P14: DISCONTINUATION AND NON-PUBLICATION OF SURGICAL RANDOMISED CONTROLLED TRIALS IN THE SETTING OF ILEUS: OBSERVATIONAL STUDY
Authors: Helliwell JA , Chapman SJ , Jayne DG 
Published: April 2021

Abstract

Introduction
Once regarded as an inevitable occurrence after surgery, ileus is now recognised as an unmet clinical need. Despite this, few studies have shown meaningful clinical benefit which may be due to the challenges associated with conducting trials in this setting. The aim of this study was to determine the rate of discontinuation and non-publication of randomised controlled trials (RCTs) in the setting of ileus.

Method
A systematic search of ClinicalTrials.gov was performed using the keyword “ileus”. RCTs registered between 2003-2019 involving abdominal surgery were eligible. Studies were divided according to completion status. Authors were contacted to seek information about the circumstances for discontinuation and non-publication. For completed studies, evidence of a published manuscript was sought.

Result
Of 262 trials identified, 81 were eligible for analysis. Amongst 27 discontinued trials, email addresses were identified for 24 (88.9%) and replies received from 6 (25.1%). The most common reasons for discontinuation were loss of clinical significance (n=2) and insufficient recruitment (n=2). Amongst 54 completed studies, manuscripts were identified for 34 (63.0%). Of these, email addresses were identified for 12 (60.0%) and replies received from 5 (41.7%). The most common reason for non-publication was a lack of time/resources/personnel (n=3).

Conclusion
One third of trials undertaken were discontinued and of those which did reach completion, less than two thirds reported results. A lack of resources and loss of clinical significance were predominant reasons. There is an urgent need to address methodological barriers in research relating to ileus to promote rigorous evaluation of new treatments.

Take-home message
One third of trials undertaken were discontinued and of those which did reach completion, less than two thirds reported results. A lack of resources and loss of clinical significance were predominant reasons. There is an urgent need to address methodological barriers in research relating to ileus to promote rigorous evaluation of new treatments.