bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-O05 Deconstructing Operations to Improve Recording of Surgical Training Experience
Authors: Dewi Ffion , Scroggie Darren , Pathak Samir , Blencowe Natalie , Hollowood Andrew , Strong Sean , Jah Asif , Smith Andrew , Van Laarhoven Stijn 
Published: December 2021

Abstract

Background
A new outcomes-based curriculum is soon to be implemented for UK surgical trainees. Performance will be evaluated against the standard expected of a new consultant. Accurate recording of operative experience and performance will therefore be crucial to demonstrate achievement of this standard. The current eLogbook system for recording surgical experience has many benefits including simplicity and accessibility, but may misrepresent actual experience because most operations are considered as a whole; unlike some colorectal operations, involvement in steps within many upper gastrointestinal (UGI) operations cannot be recorded.

Methods
Impact on training by the COVID-19 pandemic led to discussion and identification of cultural and logistical barriers to accurate recording of experience. To address these, a modification to enhance the current eLogbook system was developed by trainees and trainers at a university teaching hospital. An existing typology was used to deconstruct common UGI operations into their component steps, which can be recorded at this more detailed level.

Results
The modified deconstructed logbook concept is described using a worked example, which can be applied to any operation. We also describe the integration of a component-based training discussion into the surgical team brief and debrief; this complements the deconstructed logbook by promoting a training culture.

Conclusions
Using the described techniques, trainees of all levels can comprehensively and accurately describe their surgical experience. Senior trainees will benefit from recording complex operations which they are not expected to complete in their entirety, whilst less experienced trainees will benefit from the ability to record their involvement in more basic parts of operations. The suggested approach will reduce misrepresentation of experience, encourage proactive planning of training opportunities, and reduce the impact of crises such as pandemics on surgical training.
P-O10 Mortality and Morbidity Reporting Quality
Authors: Abbas Kazim , Kausar Ambareen , Chang David 
Published: December 2021

Abstract

Background
Mortality and morbidity (M&M) meetings in surgery are an important quality assurance process. These meetings contribute to learning, education and improvements in patient care. In order to achieve these outcomes effectively, M&M meeting require robust structure and process including accurate documentation of complications. Our hepato-pancreatico-biliary (HPB) unit conducts and records weekly M&M meetings based on consultant reported complications. However as there was no standardized documentation method of complications there was possible under-reporting. This realisation acted as a basis to investigate the robustness of our current reporting methodology of surgical complications and recommend changes in practice to achieve quality improvement.

Methods
Patients were selected retrospectively (May 20 - Sep 20) from M&M recording excel sheet which is maintained through our weekly meetings. Patient undergoing major HPB cancer resections were included. Day case procedures were excluded.
Complications reported on excel sheet were compared against any additional mis-reported complications through review of online discharge letters, discharge summaries & investigations.
The primary aim of this quality improvement project was to identify mis-reported complications. The secondary aims were to compare any change in Comprehensive complication Index (CCI) following addition of mis-reported complications.

Results
Total number of patients included in the study were n = 46. Postoperative surgical complications were recorded for n = 27 patients. 19 patients were identified to have unreported complications. Total number of unreported complications were 34. This amounted to average unreported complication per case at 1.78. Average CCI score was 14.4 before inclusion of unreported complications. There was a significant rise in average CCI score to 35.8; an increase of 21.6 CCI score after inclusion of unreported complications.

Conclusions
Unreported complications following major HPB cancer resection impact the quality of learning and education process in M&M meetings. It is essential to make complications reporting a robust process to prevent mis-reporting. We recommended use of Clavein-Dindo complications grading form as part of surgical clerking. This would help real time recording of surgical complications during postoperative journey of patients, help capture even minor complications. It would also be recommended to get these forms countersigned by responsible consultants before discharge of patients.
P-O13 Spontaneous Splenic Rupture as first presentation of Chronic Myeloid Leukaemia
Authors: McCollum Catherine , Khan Khurram , Gall Lewis , Macdonald Andrew 
Published: December 2021

Abstract

Background
Although rare, spontaneous splenic rupture (SSR) is a potentially life threatening condition and most commonly associated with infection and malignancy. Haematological malignancies are an important differential diagnosis and among these chronic myeloid leukaemia (CML) has one of the highest associations with SSR.

Methods
This case report follows a previously fit and healthy thirty-three year old gentleman who presented to accident and emergency with one day history of sudden onset, severe, left upper quadrant pain. CT of the abdomen and pelvis including an arterial phase, confirmed splenic rupture with moderate volume haemo-peritoneum, but no active bleeding. White cell count (WCC) was 225.8 x10^9/l and blood film confirmed suspicion of haematological malignancy. The patient was haemodynamically stable and therefore transferred to the surgical high dependency unit for observation and conservative management. He was commenced on hydroxycarbamide on the advice of haematology.

Results
Genetic screening detected BCR-ABL1 and Philadelphia chromosome; this along with bone marrow aspirate confirmed diagnosis of CML. His WCC decreased with hydroxycarbamide therapy. He made good clinical progress and was discharged home with haematology follow up. Hydroxycarbamide has since been stopped and he has been initiated on Imatinib therapy. His WCC has returned to normal and he has remained well with no further complications.

Conclusions
SSR is an extremely rare first presentation of CML. Given its associated morbidity and mortality, it should remain an important differential diagnosis in patients presenting acutely to the General Surgeon with abdominal pain and shock, especially in those with a known underlying haematological malignancy.
P-O18 Pancreatic Enzyme Replacement Therapy in Upper GI Surgery- A Retrospective Audit
Authors: Chalmers Naomi 
Published: December 2021

Abstract

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

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

Results
66.6% of total gastrectomies were commenced on PERT with 68.1% reporting an improvement in symptoms and 27.2% reporting some improvement. 34.7% of subtotal gastrectomies were commenced on PERT and 100% of these patients experienced symptomatic relief. 22.4% of oesophagectomies were commenced on PERT with 68% reporting an improvement in symptoms and 9% some improvement. 33% of the colonic interpositions were commenced on PERT with 100% of patients reporting an improvement with symptoms. PEI was not identified in palliative bypass or GIST surgery.
No significant improvement in weight was seen 9-12 months post-operatively in patients who began Creon 0-3 months after their operation, with a p-value of 0.19. Not enough grip strength data was available to analyse. The average final PERT dosage in patients that reported some improvement to improvement in symptoms was 50,000 – 75,000 units with every meal and snack.

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Conclusions
This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this. For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.