bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC19 The predictive role of cardiopulmonary exercise testing in gastric cancer surgery
Authors: Chmelo Jakub , Prasad Pooja , Brown Joshua , Navidi Maziar , Phillips Alexander W 
Published: December 2021

Abstract

Background
The role of Cardiopulmonary Exercise Testing (CPET) prior to major surgery has been an area of growing interest over the last two decades. CPET offers an objective and composite measure of physiological functional reserve, and thus can be used to identify patients at highest risk of peri-operative morbidity and mortality. Although the role of CPET has been investigated with respect to outcomes after oesophagectomy, no clear data exist into the predictive role of CPET specifically relating to gastric cancer surgery. The aim of this study was to identify CPET parameters predictive of adverse outcome in patients undergoing curative gastric resections.

Methods
Patients who underwent CPET followed by curative total or subtotal gastrectomy for gastric or junctional adenocarcinoma between January 2013 and December 2019 in a single high-volume centre were included in retrospective analysis. CPET variables were categorised as per cut-off values from other surgical populations (AT &lt; 11ml.min-1.kg-1, VO2peak&lt;15ml.min-1.kg-1, VE/VCO2 at AT &gt; 34). Associations between these variables and postoperative outcomes were analysed using chi squared or Fisher’s exact test.

Results
There were 252 patients included in the study. Patients with VE/VCO2&gt;34 were more likely to return to the intensive care unit (ICU) (p = 0.033) and had a higher chance of in-hospital mortality (p = 0.012). AT &lt; 11ml.min-1.kg-1 or VO2peak&lt;15ml.min-1.kg-1 were not associated either with return to ICU (p = 0.243, p = 0.202) or with in-hospital mortality (p = 1.000, p = 1.000).

Conclusions
Although much has been published on the importance of CPET assessment prior to major abdominal surgery, there is a paucity of literature specifically looking at its role in patients with gastric cancer. Patients with ventilatory inefficiency (VE/VCO2&gt;34) are more likely to return to ICU or to die during hospital stay after total/subtotal gastrectomy for malignant disease. This information should play a more prominent role when assessing patients’ fitness prior to surgery.
P-OGC30 High volume oesophagogastric resection in a small private hospital during COVID 19, April 2020- April 2021
Authors: Knight William , Theophilidou Elena , Hossain Tanvir , Hatt Jake , Yanni Fady , Zanotti Daniela , Catton James , Welch Neil , Vohra Ravi , Parsons Simon 
Published: December 2021

Abstract

Background
Like other hospitals at the peak of the pandemic, our institution had limited elective critical care capacity. This study summarises the outcomes of patients undergoing oesophagogastric (OG) resection at our institution, treated as the result of the emergency national contract between the NHS and the independent sector hospitals.

Methods
Patients undergoing OG resection at our institution between April 2020 and April 2021 were included. Patients were managed through the multidisciplinary team and were treated according to standard ERAS pathways, involving critical care input. National OG Cancer Audit (NOGCA) metrics were collected and compared to pre-COVID data.

Results
81 patients underwent oesophagogastric resection in the private sector (60 oesophagectomies). Median length of stay was 9 days (9 pre-COVID). This included 21 patients who were repatriated to our main centre for ongoing management. 30-day mortality was 3.7% (1.8% pre-COVID), 90-day mortality 6.7% (4.2% pre-COVID). This included one patient who contracted COVID following discharge. 9 patients suffered an anastomotic leak, equating to a leak rate of 11% (7% pre-COVID). 22 resections were performed at our main centre (110-140 OG resection pre-COVID)

Conclusions
It is likely the private institution in this study represented one of the busiest oesophagogastric centres in the UK during COVID-19. A large cohort of patients underwent potentially curative surgery as a result of the emergency contract, who would have otherwise been placed on prolonged or palliative chemotherapy. 30 and 90-day mortality and anastomotic leak rates were higher than pre-pandemic levels, reinforcing the value of centralised tertiary OG resection services.
P-OGC31 Robotic Upper GI Surgery: Is it Feasible, Safe and Can it Improve Patient Outcomes?
Authors: Chaudhury Madhu , Johnson Judith , Pursnani Kishore , Turner Paul 
Published: December 2021

Abstract

Background
Robotic surgery has been increasingly applied in different specialties. The Rosemere Cancer Foundation funded the Da Vinci robot for Upper GI services at our tertiary Upper GI Cancer Centre which serves a population of approximately 1.5 million people. In 2017, two of our UGI surgeons performed the first robotic GIST excision in the UK successfully. The patient was discharged 5 days later after an uneventful recovery. We have subsequently performed increasingly complex benign and malignant Robotic UGI procedures. Our primary and secondary aims looked at the length of stay (LOS) in critical care and the complete hospital admission.

Methods
Two UGI Consultants observed cases in established centres in Netherlands and Germany. Following this, they undertook 60 hours of simulation practice, online modular training and 3 sessions of wet lab training. Their initial 10 resections were completed under proctorship. A database was designed collecting information from the notes, November 2017 till July 2021 prospectively. This database was compared against a retrospective database on the same outcomes for non robotic cases over the same time period, performed by the same surgeons. LOS was statistically assessed using Mann-Whitney U test.

Results
As of July 2021, we have completed 73 cases. These are 25 benign and 48 cancer cases. The M:F was 1.5:1 and the median age was 66 years (22-84 years). The primary and secondary outcomes are illustrated below.

Conclusions
Robotic Upper GI surgery is safe and feasible with good short term outcomes. There is a reasonable learning curve and therefore a structured learning programme is needed before embarking. The main advantage from preliminary data suggests a reduction in the LOS in critical care. The cost-effectiveness in complex benign surgeries remains to be determined with increase volume of cases.

P-OGC31 Figure 1
P-OGC38 The Impact of the COVID-19 Pandemic on Barrett’s Oesophagus and Oesophago-gastric Cancer
Authors: Turkington Richard C , Lavery Anita , Donnelly David , Gavin Anna T , McManus Damian T , Cairnduff Victoria , McShane Charlene M , Johnston Brian T , Anderson Lesley A , Coleman Helen G 
Published: December 2021

Abstract

Background
The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide, affecting the diagnosis of oesophago-gastric (OG) cancer and Barrett’s oesophagus (BO). As coronavirus infection rates rose many professional bodies advised that all endoscopy, except emergency and essential procedures be stopped immediately. We sought to quantify the decline in OG cancer and BO diagnoses following implementation of British Society of Gastroenterology (BSG) guidance related to COVID-19 and the psychosocial effects on BO patients.

Methods
We examined OG cancer and BO diagnoses in Northern Ireland from March-September 2020 and compared them with the three-year average number of patients during the same time period (corresponding to weeks 10-37) between 2017-2019 by utilising Northern Ireland Cancer Registry (NICR) data. The psychosocial impact of COVID-19 was assessed using an online survey, which included validated WHOQOL-BREF and EQ-5D-5L quality of life measures, and was completed by 24 BO patients from April-May 2020.

Results
Between March and September 2020 in Northern Ireland, the proportion of OG cancer and BO diagnoses declined by 26.6% and 59.3%, respectively, compared to expected levels. In April, BO diagnoses fell by 95.5% but by September, whilst OG cancer rates had returned to baseline, BO cases remained supressed by approximately 20%. We estimate that these declines in diagnosis represent 53 ‘missed’ OG cancer and 236 ‘missed’ BO diagnoses. In the online survey sample, BO patients reported consistently lower quality of life scores than population norms, and highlighted a number of concerns with regard to their health and care.

Conclusions
The COVID-19 pandemic has resulted in an abrupt decline in OG cancer and BO diagnoses and has profoundly impacted the wellbeing of BO patients. Our study represents the first report of the impact of COVID-19 on the diagnosis of BO. Strategies to mitigate the ongoing effects of the pandemic are urgently required to preserve the ability to rapidly detect and diagnose cancer and pre-malignant conditions.
P-OGC43 Morbidity and unplanned hospital attendance among patients with oesophagogastric cancer treated with home enteral nutrition
Authors: Olusona Okiki , Brett Orla , White Cathy , Hickey Wendy , Coleman Claire , Elliott Jessie A , Arumugasamy Mayilone , Robb William B 
Published: December 2021

Abstract

Background
Nutritional optimisation is an essential component of prehabilitation and enhanced recovery for patients with oesophageal and gastric cancer, but may be associated with increased burden of inpatient care. The aim of this study was to determine risk factors associated with complications and unplanned hospital attendance among patients treated with home enteral nutrition.

Methods
Consecutive patients with oesophageal or gastric cancer commencing home enteral nutrition from March 2020-June 2021 were prospectively studied. The primary outcome measure was the incidence of complications associated with home enteral feeding requiring unplanned hospital attendance. Univariable and multivariable linear and logistic regression were used to determine factors independently associated with enteral feeding associated morbidity and healthcare utilisation.

Results
70 patients were studied (27% pre neoadjuvant therapy, 63% postoperative; 19% gastrostomy, 81% jejunostomy). Tube complications requiring unplanned hospital attendance occurred in 33% of patients (25% gastrostomy, 38% jejunostomy, P = 0.405), most commonly dislodgement (15%), fixation problem (13%), and blockage (6%). Small bowel obstruction was rare (1.4%). Inpatient length of stay (LOS) following feeding tube placement and training was 5.1±2.4 days (gastrostomy: 5.5±2.7, jejunostomy: 4.4±1.9 days, P = 0.074). 17 unplanned hospital visits among nine patients (13.0%) occurred with a cumulative LOS of 71 inpatient days. On multivariable analysis patients undergoing neoadjuvant therapy were at the greatest risk of overall enteral feeding tube morbidity (OR19.34 [3.29–113.56], P = 0.001), dislodgement (OR19.09 [2.35-155.11], P = 0.006) and unplanned hospital attendance (P &lt; 0.001). Older patients were at increased risk of tube dislodgement (OR1.14 [1.02–1.28], P=0.024) and unplanned hospital attendance (P = 0.034).

Conclusions
Unplanned hospital attendance is common among patients undergoing supplemental home enteral nutrition during treatment for oesophagogastric cancer. Fixation problems and dislodgement account for the majority of presentations, and are more common among older patients and those undergoing neoadjuvant therapy. Pragmatic strategies to optimise tube fixation and minimise the need for unplanned hospital visits among patients receiving home enteral nutrition are urgently needed.
P-OGC59 Pattern of recurrence following neoadjuvant treatment and two-stage oesophagectomy for oesophageal/junctional adenocarcinoma: 10-year results from a high-volume centre
Authors: Brown Joshua , Calabrese Michele , Chmelo Jakub , Prasad Pooja , Phillips Alexander 
Published: December 2021

Abstract

Background
Disease recurrence remains high following oesophagectomy for oesophageal and junctional adenocarcinoma in spite of the incremental gains from improved neoadjuvant treatment (NAT). Follow-up remains important for the detection and treatment of recurrence, although the optimum surveillance strategy remains undefined. Recurrence after treatment can occur locoregionally, distantly, or a combination of both. This retrospective review of a single, high-volume centre’s 10-year experience has sought to determine the pattern of recurrence in those who have received curative NAT followed by two-stage subtotal oesophagectomy (2S-STO) for oesophageal and junctional adenocarcinoma.

Methods
A retrospective analysis was performed on a cohort of patients from a high-volume, single centre between January 2009 and January 2019 who had confirmed disease recurrence after receiving NAT and 2S-STO for either oesophageal or junctional (Siewert I/II) adenocarcinoma. The Unit’s prospectively collected cancer database was utilised as well as patients’ notes to determine the pattern of recurrence seen in this cohort. Patients receiving a three-stage or transhiatal oesophagectomy for any cause, or those diagnosed with squamous cell carcinoma were excluded.

Results
215 patients were identified with recurrence following NAT and 2S-STO for oesophageal/junctional adenocarcinoma within the 10-year period. The median age was 69 (range 23-85) with 67% being male and 33% female. The median time to diagnosis of recurrence was 13 months following surgery. 87 (40%) patients were diagnosed with locoregional recurrence, with the commonest pattern being in mediastinal or abdominal lymph nodes, followed by peritoneal disease. 62 (29%) patients were diagnosed with distant recurrence, with the vast majority being in the liver or lungs. 66 (31%) patients had evidence of both locoregional and distant spread at diagnosis of recurrence.

Conclusions
The incidence of recurrence following curative treatment for oesophageal and junctional adenocarcinoma remains high. Locoregional disease appears to be the commonest pattern of recurrence as identified in this study, which would confirm spread predominates via the lymphatic and transcoelomic routes. Liver and lung remain the commonest sites for haematogenous spread, although other sites include adrenal, brain and bone. Although the optimum follow-up strategy remains undefined in such patients, timely investigation of symptoms is required for early diagnosis so as to optimise the benefits of palliative treatment.
P-OGC67 Gastric GISTs: Can presentation, Location and Radiological Features predict behaviour? – Experience in a UK cohort
Authors: Gerretsen Hannah , George Gincy , Russell Beth , Gossage James , Kelly Mark , Davies Andrew , Baker Cara 
Published: December 2021

Abstract

Background
Gastrointestinal stromal tumours (GISTs) most commonly arise in the stomach, vary significantly in behaviour and can be difficult to risk stratify accurately pre-operatively. They are increasingly being identified incidentally during endoscopies or cross-sectional imaging. They have malignant potential and but vary from very low to high-risk. Pre-operatively, histological diagnosis can be achieved by performing endoscopic ultrasound (EUS) guided fine-needle aspirate or biopsy, but samples often contain insufficient material. This study aims to assess other features help identify aggressiveness of GISTs pre-operatively to help guide management decisions.

Methods
This is a retrospective cohort study analysing patients treated surgically for GIST from 2011-2020 at a UK tertiary centre. Exclusion criteria were non-gastric GISTs and patients who received a different diagnosis post-operatively. Hospital electronic patient record and e-noting systems were used to collect data. Risk groups were stratified according to the NCCN risk classification for GIST. ‘Very low risk’ and ‘low risk’ groups were combined in the analysis to form the ‘lower risk’ group; ‘moderate risk’ and ‘high risk’ categories combined to form the ‘higher risk’ group. Statistical analyses were conducted using STATA version 15.

Results
171 patients were included in total. OGD diagnosed gist on histology if ulcerated in 14.7% of cases. EUS biopsy was performed in 39% of cases pre-operatively – 84.6% of these were diagnostic. There was a higher proportion of higher risk GISTs in the GOJ/cardia region than lower risk GISTs (16.2% versus 6.7%), though this did not reach statistically significance (p = 0.32). A greater proportion of higher risk tumours were irregular in outline (p=.26), heterogenous (p = 0.003) and necrotic (p = 0.001) than lower risk tumours. In addition, higher risk tumours were significantly more likely to be exophytic than lower risk tumours, which were significantly more endophytic (p = 0.05). A ROC curve including all the variables had an AUC of 0.8971.

Conclusions
This is the largest analysis of gastric GISTs in a UK population. This study found that a higher proportion of higher risk tumours were irregular, heterogenous and necrotic than lower risk tumours. In this study, a greater proportion of higher risk tumours arose in the GOJ/cardia. In keeping with muscularis origin, endoscopic biopsy was found to be a poor diagnostic tool unless ulcerated. EUS and FNA biopsies had a much higher rate of histological confirmation. This knowledge might help facilitate a more individualised approach with non-operative surveillance in lower risk tumours or expedited surgery in higher risk lesions.
P-OGC97 Development and piloting of surgical quality assurance methods for randomised controlled trials (RCTs): an example from a trial comparing laparoscopically assisted oesophagectomy vs. open oesophagectomy
Authors: Blazeby Jane , Blencowe Natalie , Skilton Anni , Shirkey Beverly , Ward Liz 
Published: December 2021

Abstract

Background
RCTs in surgery are frequently criticised because the standard to which operations are performed (quality assurance - QA) is not considered during study design and delivery, risking performance bias. Lack of clarity about surgical QA may also influence the successful implementation of RCT results into routine practice, because it is unclear how procedures were undertaken. We developed QA measures for an RCT comparing laparoscopically assisted and open oesophagectomy (LAO and OO).

Methods
Five QA categories were developed during the pilot and applied to the main trial, using data from patients receiving their randomized allocation in each group: i) entry criteria for centres; ii) entry criteria for surgeons; surgical protocols for key components of LAO and OO with mandated, prohibited and flexible components, monitored using iii) case report forms (CRFs) to record protocol adherence; and iv) intra-operative photographs to demonstrate protocol adherence (using the visible anatomical structures to determine if the component had been fully completed); and v) lymph node count and length of oesophagus.

Results
8 centres and 39 surgeons participated and met entry criteria. 145 (LAO) and 149 (OO) patients underwent their randomized surgical procedure. Key procedural components were reported as complete in CRFs at similar rates in both groups, with &gt;70% undergoing mandated components. However, adherence assessed using photographs was consistently lower than the CRFs. For example, left gastric artery lymphadenectomies were reported as complete in &gt; 98% CRFs (LAO and OO) whereas photographs found this to be complete in 42% (OO) and 54% (LAO). Median nodal count was similar in both groups (145 LAO=24.7, SD = 10.6 and 149 OO = 26.4, SD = 10.2) as was length of resected oesophagus.

Conclusions
Assessing surgical QA in a multi-centre trial is logistically challenging but feasible. Whilst video data from laparoscopic cases could be collected and assessed, it was not possible with open surgery. Understanding adherence to the study protocol using photographs in addition to CRFs was important because of marked differences between what surgeons reported had been undertaken and images of what had been achieved. It is recommended that surgical trials include QA processes to understand protocol adherence and examine performance bias between groups.
P-P19 Incidentally detected Double Duct Sign (InDDuS): a study on the long-term outcomes
Authors: Yao Lu , Aroori Somaiah 
Published: December 2021

Abstract

Background
The long-term outcomes of patients with biliary and pancreatic ductal dilatation (double duct sign-DDS), without a detectable underlying cause, is unclear in the current literature. This study aims to review the five-year outcomes of patients with incidentally detected double duct sign.

Methods
This is a retrospective study of patients that were found to have DDS between January 2010 to December 2015 at a tertiary referral Hepato-Pancreatico-Biliary unit. Patients were identified from the departmental performance team and cross-checked with the Radiology department. Patients who had malignancy and benign causes of DDS (such as pancreatitis and gallstones) were excluded. Five-year patient outcomes were collected from subsequent MDT outcomes and clinic letters.

Results
Initial screen identified 108 patients with DDS. Of these, 37 patients (81% female, median age 69 years, range 26-94 years) had no identifiable cause and were analysed. Main presenting complaints were abdominal pain (n = 22), weight loss (n = 9), and asymptomatic (n = 3). Twelve had anaemia, 14 had derange LFTs and 2 patients had elevated serum CA19-9. A median of two (range 0-9) further investigations were performed to determine the underlying cause of DDS (US = 6, CT = 24, MRCP=17, endoscopy=16). Median follow up of 7.2 (range 5-11) years detected no pancreatic or ampullary cancer amongst all patients.

Conclusions
Results from this study suggests DDS without evidence of malignancy on Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) have minimal risk of developing pancreatic or ampullary cancer in the next five years. Thus, they can be safely discharged from follow up.
P-P20 ‘Fast Recovery’ A multidisciplinary approach to improving recovery after pancreatic resection and ultimately increasing uptake of adjuvant chemotherapy
Authors: Powell-Brett Sarah , Pande Rupaly , Hodson James , Mann Samantha , Freer alice , Wyrko Zoe , Hughes Clare , Isaac John , Sutcliffe Robert , Roberts Keith 
Published: December 2021

Abstract

Background
Pancreatic cancer surgery has a multi-system impact on a potentially vulnerable population. Current rates of adjuvant chemotherapy uptake are low. Our group developed a multidisciplinary bundle of care with the aim of improving recovery after surgery. The primary aim was to improve uptake of adjuvant chemotherapy and the secondary aim was to prevent nutritional decline.

Methods
This prospective, observational, cohort study evaluated the effect of the ‘Fast Recovery’ programme. This programme, developed with input from dieticians, physiotherapists, surgeons, and geriatricians and comprising pre- and post-operative frailty assessments, nutritional support and physiotherapy was implemented for all within our unit undergoing pancreatic resection for cancer. (See Fig. 1)

Results
Over 1 year, patients enrolled in the Fast Recovery programme (N = 44) were compared to those treated prior to the pathway change (N = 409). The Fast Recovery programme was not associated with a significant increase of adjuvant chemotherapy uptake (80.5 vs. 74.3%, p = 0.452), but did lead to a significantly lower average weight loss (4.3 vs. 6.9kg, p = 0.013). Patients that did not receive adjuvant chemotherapy performed significantly worse on a pre-operative six minute walk test (mean distance: 277 vs. 454 metres, p = 0.001).

Conclusions
Feasibility of a multimodal package to improve patient care following pancreatic resection has been shown by this pilot study. No significant improvement in the chemotherapy uptake was observed, however, this was potentially a result of the study being underpowered. Pre-operative physical assessments were found to be predictive of adjuvant chemotherapy uptake and could potentially be used to identify those in need of additional support. Further work is needed to evaluate the routine use of such a programme.