bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC68 Prophylactic Endoluminal Vacuum Therapy (EVT) following oesophagectomy
Authors: Afzal Zeeshan , Gourgiotis Stavros , Hardwick Richard , Safranek Peter , Sujendran Vijayendran , Bennett John , O'Neill Robert , Noorani Ayesha , Hindmarsh Andrew 
Published: December 2021

Abstract

Background
Endoluminal vacuum therapy (EVT) is an emerging treatment strategy for the management of anastomotic leaks following oesophagectomy. However, patients are often critically unwell with mediastinitis and established sepsis by the time the leak is diagnosed. This results in a protracted recovery period regardless of the effectiveness of EVT in treating the leak. Prophylactic EVT to protect the anastomosis following oesophagectomy may reduce the incidence of anastomotic leak, and/or mediastinitis and sepsis if the anastomosis does fail. We report the outcomes of two patients considered high risk for anastomotic leak who were managed with prophylactic EVT following esophagectomy for cancer.

Methods
Two patients received prophylactic EVT following oesophagectomy between May and July 2021. The patients were considered high risk for anastomotic leak due to technical concerns with, or complications during, the operation. In both cases the oesophagogastric anastomosis (OGA) was fashioned with a circular stapler. The endoluminal vacuum device (EVD) was constructed using an 18F nasogastric tube and a piece of open cell foam, and placed intraluminally across the anastomosis under endoscopic guidance at the time of surgery. Continuous negative pressure (125mmHg) was applied. Information relating to treatment and outcome was recorded prospectively.

Results
Patient-1, a 72-year-old female, ASA 2, underwent minimally invasive oesophgectomy for an adenocarcinoma at the gastro-oesophageal junction. After creating the stapled OGA, inspection revealed the proximal (oesophageal) tissue doughnut was complete but attenuated. Patient 2, a 67-year-old male, ASA 3, underwent a hybrid Ivor Lewis oesophgectomy for a lower 1/3 oesophageal adenocarcinoma. Surgery was complicated by significant intra-abdominal bleeding requiring blood transfusion and pressor support. In both cases, endoscopic assessment of the anastomosis following removal of the prophylactic EVD was performed day seven post-operatively. The anastomoses were healthy with no evidence of a leak, dehiscence, or early stricture formation.

Conclusions
In this limited case series, prophylactic EVT of the OGA following oesophagectomy was delivered safely with no complications related to insertion of the EVD or delivery of EVT. This intervention should be considered in cases where the risk of anastomotic leak is high. An intraluminal EVD situated across the OGA may minimise the extent of extraluminal contamination, and the systemic consequences of sepsis associated with this, should an anastomotic breakdown occur. Further studies are required to determine the safety of prophylactic EVT following oesophagectomy, and whether this improves surgical outcomes by reducing the incidence and impact of anastomotic leaks.
P-OGC73 Effect of pyloroplasty on the need for endoscopic intervention for delayed gastric emptying post oesophagectomy
Authors: Chien Siobhan , Khan Khurram , Gall Lewis , Craig Carol , MacKay Colin , Macdonald Andrew , Forshaw Matthew 
Published: December 2021

Abstract

Background
Delayed gastric emptying (DGE) is a common complication following oesophagectomy, affecting 15-39% of patients. Controversy remains regarding the role of pyloric drainage procedures during oesophagectomy with gastric conduit reconstruction in reducing DGE. This study investigated the effect of pyloroplasty at the time of oesophagectomy on the need for endoscopic pyloric intervention post-operatively.

Methods
We performed a retrospective analysis of all oesophagectomies performed in a single tertiary centre over a 10-year study period between 1 January 2010 and 31 December 2019. Electronic records were reviewed to analyse patient demographics, operative details and post-operative outcomes, as well as the need for endoscopic procedures after surgery. Patients were dichotomized into two groups, with those who had pyloroplasty performed at oesophagectomy compared to those who did not. Patients who died ≤30 days after oesophagectomy were excluded from analysis. Patients were followed up for a median of 32 months (IQR 19-60).

Results
298 patients were eligible for the study, of whom 80/298 (26.8%) had a pyloroplasty performed. Demographics were evenly matched between the two groups. Patients undergoing Ivor-Lewis oesophagectomy were significantly more likely to have had pyloroplasty performed (90.0% vs. 24.3%; p &lt; 0.001). Pyloroplasty had no significant effect on post-operative complication rates, ICU admission, need for re-operation or length of hospital stay. Patients without a pyloroplasty were significantly more likely to require endoscopic pyloric balloon dilatation (43.1% vs. 12.4%, p &lt; 0.001) or pyloric botox injection (12.4% vs. 3.8%, p = 0.029) after oesophagectomy.

Conclusions
In this study, patients who had a pyloroplasty at the time of oesophagectomy were significantly less likely to require endoscopic pyloric balloon dilatation and/or pyloric botox injection post-operatively. This has significant long-term implications for both patients’ quality of life post-operatively and demands on over-stretched endoscopic services.
P-OGC84 Impact of routine feeding via jejunostomy after oesophagectomy
Authors: Khaw Rachel A , Macdonald Jill , Munro Samuel , Phillips Alexander W 
Published: December 2021

Abstract

Background
Oesophageal cancer is the 8th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed placement have looked to tackle this. Our aim was to investigate the impact of supplemental jejunostomy feed in practice on mortality, length of hospital stays and postoperative weight loss in a high-volume regional centre.

Methods
Patients undergoing oesophagectomy between January 2012 - December 2014 and January 2016 - December 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Survival data were analysed using R Studio, Inc.

Results
566 patients were included. Median age at diagnosis was 66 years (30-85). Majority of cases included were adenocarcinoma (72.6%), or squamous cell carcinoma (22.3%). Within the two study groups, severe weight loss &gt; 10% of pre-operative weight was seen in 38.6% and 4.87% of patients discharged without and with jejunostomy feeds at 3 months, respectively. At 6 months, severe weight-loss was seen in 47.6% and 0.64% of patients discharged without and with jejunostomy feeds, respectively. Median length of stay was 15 days (7-92) and 12 days (6-338) for patients discharged without and with jejunostomy feeds, respectively. Overall median survival in patients discharged without jejunostomy was 52 months (p = 0.035), and in those discharged with jejunostomy, 48 months (p = 0.044).

Conclusions
Postoperative malnutrition has associated poor outcomes. Perioperative nutritional support, to include postoperative jejunal feeding post-discharge can reduce weight loss, and influence survival as well as length of hospital stay. Further randomised trials are needed in order to optimise recovery and morbidity in patients post-oesophagectomy.
P-OGC86 Textbook Outcome following Oesophagectomy for Oesophageal Cancer: An International Cohort Study
Authors:   Oesophagogastric Anastomosis Audit Collaborative
Published: December 2021

Abstract

Background
Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting.

Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%).

Results
This study included 2,159 patients with oesophageal cancer, of whom 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender, increasing Charlson comorbidity index, and higher AJCC T and N staging to be associated with a significantly lower likelihood of TO. After accounting for these factors, high volume centres (&gt;50 cases/year; OR: 1.36, CI95%: 1.06 - 1.75, p = 0.015), presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.11, CI95%: 1.33 - 3.35, p = 0.001) and radiology (OR: 1.56, CI95%: 1.08 - 2.26, p = 0.019), total minimally invasive esophagectomies (OR: 1.60, CI95%: 1.25 - 2.05, p &lt; 0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58 - 2.98, p &lt; 0.001) were independently associated with a significantly increased likelihood of TO.

Conclusions
TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.
P-OGC94 Outcomes of oesophagectomy post endoscopic mucosal resection
Authors: Yahya Muhammad Syafwan , Kennedy Andrew , Kennedy Raymond , McManus Damian , Harris Andrew , MacAulay Graeme 
Published: December 2021

Abstract

Background
Within developed nations, oesophageal adenocarcinoma has the greatest incidence of any solid organ tumour with number escalating on a yearly basis. A recent expert review by the AGA suggests that high grade Barrett’s dysplasia and intramucosal adenocarcinoma are better treated endoscopically rather than oesophagectomy and that endoscopic management is a reasonable alternative to oesophagectomy for selected patients with low risk pT1b tumours.. Risk factors for nodal involvement and recurrence have been suggested by Lee et al (1). This study aims to review the pathological and clinical outcomes following oesophagectomy post EMR.

Methods

Results

Conclusions
Whilst some low risk patients had residual tumour at oesophagectomy, these findings were similar to Nelson et al 3; recurrent/recurrent local tumour could be potentially managed by repeat EMR. The absence of nodal metastasis in this small series is consistent with the AGA recommendation of EMR as a reasonable alternative to oesophagectomy for patients with selected low risk pT1b tumors.
P-P02 Incidence and risk factors for chyle leak after pancreatic surgery: a systematic review and meta-analysis
Authors: Varghese Chris , Wells Cameron , Lee Shiela , Ammar Khaled , Pandanaboyana Sanjay 
Published: December 2021

Abstract

Background
The incidence of, and risk factors for chyle leak, as defined by the 2017 International Study Group on Pancreatic Surgery (ISGPS), remain unknown.

Methods
MEDLINE, EMBASE, and Scopus were systematically searched for studies of patients undergoing pancreatectomy that reported chyle leak according to the 2017 ISGPS definition. The primary outcomes were the incidence of overall and clinically-relevant chyle leak. A random-effects pairwise meta-analysis was used to identify risk factors where possible.

Results
Thirty-five studies including 7083 patients were included in the meta-analysis. The weighted incidence of overall chyle leak was 6.8% (95% CI 5.6 - 8.2) and clinically-relevant chyle leak was 5.5% (95% CI 3.8 - 7.7). Pancreaticoduodenectomy, total pancreatectomy and distal pancreatectomy were associated with a CL incidence of 7.3%, 4.3%, 5.8% respectively. Fourteen individual risk factors for chyle leak were identified from included studies. Younger age, low prognostic nutritional index, para-aortic node manipulation, lymphatic involvement, and post-pancreatectomy pancreatitis were significantly associated with chyle leak, all from individual studies.

Conclusions
The incidence of overall chyle leak and clinically relevant chyle leak after pancreatic surgery, as defined by the 2017 ISGPS definition is 6.8% and 5.5% respectively. Several risk factors for chyle leak were identified in the present review, however, larger high-quality studies are needed to more accurately define these risks.
P-P08 Towards effective analgesia in acute pancreatitis: a systematic review of randomised controlled trials
Authors: Thavanesan Navamayooran , White Sophie , Lee Shiela , Ratnayake Bathiya , Leeds John , Nayar Manu , Sharp Linda , Siriwardena Ajith , Drewes Asbørn , Capurso Gabriele , de Madaria Enrique , Windsor John , Pandanaboyana Sanjay 
Published: December 2021

Abstract

Background
The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. The present systematic review and meta-analysis aims to compare the efficacy of several analgesic modalities trialled in AP.

Methods
A systematic search of PubMed, MEDLINE and EMBASE was conducted up until June 2021, according to PRISMA Guidelines to identify all randomised control trials (RCTs) comparing analgesic modalities in AP. The primary outcome measure was improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2.

Results
Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), placebo, local anaesthetic, epidural, paracetamol and metamizole. A weighted single-arm effects estimate showed global improvement in VAS across all modalities from baseline to day 2. On visual inspection, epidural analgesia appears to provide the greatest improvement in pain scores within the first 24hrs, however at 48hrs it was comparable to opiates. Within the first 24hrs, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant heterogeneity in pain-relief reporting with relatively small datasets per study.

Conclusions
Given the incidence of AP there is remarkable paucity of level 1 evidence to guide pain management. Epidural administration is most effective analgesic modality within the first 24hrs of AP. NSAIDs are an effective opiate sparing alternative during the first 24hrs.
P-P13 Long-term outcome after portal vein resection during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matched analysis
Authors: Russell James , Stevens Claire , Bhome Rahul , Karavias Dimitrios , Arshad Ali , Takhar Arjun , Armstrong Thomas , Primrose John , Green Brian , Hamady Zaed 
Published: December 2021

Abstract

Background
Portal vein resection (PVR) with pancreaticoduodenectomy (PD) is often performed to achieve clear margins for patients with vascular involvement in pancreatic ductal adenocarcinoma (PDAC). However, there is evidence to suggest that patients undergoing PVR often have more advanced cancers, therefore the impact of PVR on survival and recurrence remains unclear. The aim of this study is to assess overall (OS) and recurrence free (RFS) survival in patients who underwent PVR during PD, with particular attention to margin positivity.

Methods
A retrospective analysis was performed on 638 patients who underwent PD during a 12-year period. Exclusion criteria included PD for non-PDAC tumours, neoadjuvant chemotherapy or intra-operative radiotherapy. 374 patients were included in the study (90 PVR and 284 non-PVR). Patient characteristics and histopathological factors associated with OS and RFS were then evaluated using univariate and multivariate Cox regression analyses. 270 patients (90 PVR and 180 non-PVR), were matched by propensity score based on perineural invasion, pT and pN staging. The Kaplan-Meier method was used to calculate survival and log-rank tests.

Results
Resection margin positivity was associated with shorter OS and RFS (p &lt; 0.0001), and the superior mesenteric vein (SMV) margin was the most significant risk factor for survival on competing risks analysis. Absent adjuvant chemotherapy, nodal metastasis and margin positivity were independent risk factors for OS and RFS on multivariate analysis. PVR was associated with higher intra-operative blood loss (p = 0.009), but was not associated with increased length of stay, complications or readmissions. PVR patients had increased pT staging, nodal metastasis and perineural invasion, however, there was no difference in OS (p = 0.551) or RFS (p = 0.256) between PVR and non-PVR after propensity matching.

Conclusions
Positive resection margins are associated with shorter survival times, and the SMV margin is the most significant prognostic indicator for overall survival and recurrence compared to other margins. PVR is a relatively safe procedure, however, it does not achieve the intended survival benefits of complete margin clearance. The impact on survival for margin positivity, particularly the SMV margin, and nodal metastasis should be considered when making decisions with regards to vein resection and adjuvant treatments.
P-P16 Management of acute pancreatitis in a busy district general hospital
Authors: Saldanha Simon , Joshi Aparna , Niaz Osamah 
Published: December 2021

Abstract

Background
Pancreatitis is a common surgical presentation and can be life threatening, with complications such as acute respiratory distress syndrome and necrosis occurring. Due to high hospital incidence, it is important to ensure patients are managed appropriately using available guidelines. This audit aims to assess the management of acute pancreatitis in a busy district general hospital and identify areas for improvement to better patient safety.

Methods
Only cases of acute pancreatitis were used in this audit. Case notes for the period between October and December 2020 were collected respectively. A data collection proforma was created using guidelines from the British society of gastroenterology for the management of acute pancreatitis. Data was then analysed using Excel.

Results
23% of cases had documented scoring, with Glasgow-Imrie the only scoring tool used.
41% had documented oxygen saturation.
33% had been reviewed by alcohol liaison team for pancreatitis secondary to high alcohol consumption.
No patients were given the guideline’s recommended rate of fluid resuscitation (5-10ml/kg/hr).
All patients had amylase/lipase in their blood profile.
80% of patients had antiemetics prescribed should they require them, whilst 95% of patients had opioids prescribed for analgesia.
50% of patients were given antibiotics despite them not being indicated.
18% were kept nil by mouth (NBM) whilst having abdominal pain.

Conclusions
Our results suggest that guidelines for acute pancreatitis are not adequately adhered to.
Many aspects of the guidance were not followed including documentation of oxygen saturation, antibiotic use, IV fluid resuscitation and alcohol liaison review for patients who required review.
We have developed a proforma to use for the management of acute pancreatitis to ensure that cases are managed in accordance with evidence-based literature and to make the management of these cases easier.
We will reaudit to analyse the effects of our intervention and determine whether there has been an improvement in the management of acute pancreatitis.
P-P17 Casting a Wider NET: Defining PEI in patients with Neuroendocrine Tumours using the 13C-MTG breath test
Authors: Hall Lewis , Powell-Brett Sarah , Bradley Elizabeth , Thompson Oscar , Smith Stacey , Vickrage Suzanne , Kemp-Blake Joanne , Shah Tahir , Roberts Keith 
Published: December 2021

Abstract

Background
Somatostatin-analogues (SSAs) are the first-line treatment of unresectable, symptomatic neuroendocrine tumours (NETs). However, SSAs inhibit pancreatic secretions which could lead to pancreatic exocrine insufficiency (PEI). There is, however, very limited data regarding the physiologic link between SSAs and PEI. PEI negatively impacts patient quality of life (QoL), nutritional status, and clinical outcomes. This is a prospective, observational, cohort study to establish the impact of SSAs on pancreatic exocrine function in patients with NETs, using the 13C-Mixed-Triglyceride (13C-MTG) breath test.

Methods
Adult patients commencing SSA therapy for NETs, were recruited from December 2020. Patients were excluded if they had a diagnosis of other pancreatic disease, history of upper-gastrointestinal surgery that may alter pancreatic function, or already on SSA therapy. The impact of SSAs on exocrine function was assessed using the 13C-MTG breath test. A quotient of 13CO2/12CO2 was measured by mass spectrometry and the cumulative percent dose recovered at 6 hours (cPDR) is reported. Secondary endpoints investigated were changes in patient weight and Vitamin D levels.

Results
Exocrine function reduced in all patients (n = 7) following SSA therapy (median reduction from baseline: -22.2%, range: -5.6- -42.1%; p = 0.018) (Figure 1). Vitamin D levels decreased in all but one patient (median decrease from baseline: -11.7%, range: -29.3-10%; p = 0.126). Change in patient weight did not show any significant change (median decrease from baseline: -0.69%, range: -4.26 – 3.6%, p = 0.933).

Conclusions
SSA therapy appears to have a consistent impact on exocrine function from early in the treatment course. This suggests that there is a widespread underestimation of PEI in this setting. Whether such decrease in exocrine function leads to weight loss remains to be seen. Further studies are required to confirm this work, determine the clinical relevance of this observation, and optimise medical therapy of PEI in this cohort. The 13C-MTG breath test is a feasible and acceptable measure of pancreatic exocrine function in patients treated with SSA therapy for NETs.