bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-BN06 A Proposed Difficulty Grading System for Laparoscopic Bile Duct Exploration. Benefits to Practice and Research
Authors: Sallam Mahmoud , Nassar Ahmad H M , Kilpatrick Rhona , Ali Kiren 
Published: December 2021

Abstract

Background
A gap remains between the mounting evidence for single session management of bile duct stones and the obstacles to wider adoption of this approach. The practice of laparoscopic bile duct exploration (LCBDE) is limited not only by the availability of training opportunities and adequate equipment but also by the perception that the technique is difficult and requires a high skill-set. The aim of this analysis is to compare the preoperative and operative characteristics and the postoperative outcomes in easy vs. difficult LCBDE in a large consecutive series, according to a proposed 5 grade classification.

Methods
1326 LCBDEs were graded according to the location, number and size of ductal stones, retrieval techniques used, utilisation of choledochoscopy and specific biliary pathologies encountered. The cohort was divided into two groups: easy (Grades I A&B, and Grade II A&B, requiring transcystic or transductal exploration for up to 15 stones the largest being 15mm) and difficult (Grades III A&B, for over 15 stones or intrahepatic stones of any size needing transcystic choledochoscopy, IV and V with Mirizzi Syndrome, impacted stones, and ducts needing stenting, conversion or bilioenteric anastomosis). Various outcome parameters were compared.

Results
Age, sex, obesity and previous biliary admissions had no effect on operative difficulty. Emergency admission, obstructive jaundice, previous ERCP and dilated CBD were predictive of difficult explorations. 78.3% of patients with acute cholecystitis or pancreatitis, 37 % of jaundice and 46% of cholangitis had easy explorations. Transcystic stone retrieval was possible in 77.7% of easy explorations and choledochotomy required in 62.3% of difficult explorations (vs. 33.6% in the whole series). Choledochoscopy was utilised in 23.4% of Grades I&II vs. 98% in difficult explorations. As expected more biliary drains, stenting, bilio-enteric anastomosis, conversions, operative time, biliary-related complications, hospital stay, readmissions and retained stones increased with difficulty. Grades I&II patients had 2 or more hospital episodes in 26.5% vs. 41.2% for grades III to V, the median presentation to resolution interval increasing from 1 to 3 weeks. There were 2 deaths in difficulty Grade V and one in Grade IIB.

Conclusions
Difficulty grading of LCBDE is a useful tool of predicting outcomes. It facilitates comparison between studies and fair assessment of training. LCBDEs are easy in 72% and of these 77% can be completed transcystically. It is hoped this will encourage more units to adopt single session management of bile duct stones through establishing referral protocols, developing and refining the skills through training and acquiring the necessary equipment.
O-EGS01 Emergency Giant Hiatal Hernia Repairs: Experiences in fundoplication versus gastropexy
Authors: Alasmar Mohamed , McKechnie Iona , Chaparala Ram 
Published: December 2021

Abstract

Background
An emergency presentation with a hiatal hernia tends to be life-threatening with a high associated mortality rate. Operative management aims to reduce the herniated stomach, dissect the hernial sac and reapproximate the crura. This will often be followed by a fundoplication or a gastropexy to reduce the risk of recurrence. This study compares the recurrence rates between patients who underwent fundoplication and gastropexy.

Methods
Over 8 years, from October 2012 to November 2020, 80 patients were admitted to a tertiary oesophagogastric centre requiring emergency surgery to repair a giant hiatal hernia. We conducted a retrospective review and analysis of their admission and follow-up. The primary outcome measure was acute and post-discharge symptomatic recurrence of hiatal hernia, and secondary outcomes were patient mortality and readmission rate.

Results
Of the 80 patients requiring emergency hiatal hernia surgery, 38% had fundoplication procedures, 53% had gastropexy, and 3% had both (n = 30, 42, 2 respectively). One patient had neither, and 6% (n = 5) patients had a complete or partial resection of the stomach due to necrosis, so they were not suitable for gastropexy or fundoplication. Eight patients (10%) had symptomatic recurrence of hiatal hernia requiring a repeat operation; three within the index admission, five post-discharge. 50% had undergone fundoplication, 38% underwent gastropexy and 13% underwent a resection (n = 4, 3, 1)(p-value=0.5). 19% (n = 15) patients were readmitted. Post-operative mortality was 6% (n = 5).

Conclusions
Emergency surgery for giant hiatal hernias is usually complex, and a significant cohort of these patients are elderly with significant co-morbidities. Nevertheless, there is no conclusive evidence in the literature favouring fundoplication versus gastropexy. Choice of technique is influenced by the surgeon’s experience and perioperative factors that influence the duration of the operation. This review, which includes the largest cohort of patients available in the literature, demonstrates that surgical technique does not influence the symptomatic recurrence rate in our patient group.
O-EGS09 Effect of introducing an ambulatory care service on management of patients requiring acute cholecystectomy
Authors: Shahid Mishal , Hollyman Marianne , Wei Rui , Barton Jessica , Williams Lian 
Published: December 2021

Abstract

Background
Biliary pathology is a large tranche of the emergency surgical take, taking up many bed days, with many patients not receiving definitive management on their primary admission. An Emergency Surgical Ambulatory Care (ESAC) service was established at our hospital in 2019, aiming to provide a streamlined platform for diagnosis and surgical management of patients. Most notably this included patients with symptomatic gallstones which could be managed on a semi-urgent basis without hospital admission. We aim to analyse the efficiency of this novel service in hopes of identifying room for improvement so that we may enhance our patient outcomes.

Methods
Two time periods were retrospectively assessed; September-December 2018 (pre- ESAC) and September-December 2019 (six months after ESAC started). Patients with Cholelithiasis (ICD-K80) and Cholecystitis (ICD-K81) were identified, and those with either an incidental diagnosis of gallstones without symptoms, with gallstone pancreatitis, severe inflammation (empyema, gangrene, perforation), requiring ERCP or if they were unfit for surgery were excluded.
Data was collected on number of admissions, length of stay and rate of cholecystectomy. Patients were divided into 2018 SAU, 2019 SAU and 2019 ESAC to compare the difference in their outcomes. Data are presented as median (range).

Results
Some 57 patients presented acutely in 2018 compared to 82 in 2019.
The median wait to operation of 43.5 days in 2018 was significantly reduced to 7 days in 2019.

Conclusions
The introduction of an ESAC service in 2019 has allowed a reduction in number of admissions, total length of stay of patients and significantly reduced waiting time for surgery.
Use of ESAC has shown to be more efficient in terms of hospital bed occupation and indirectly, utilization of resources. The high surgical success rate also ensures fewer patients re-presenting with the same pathology to the acute take and hence contributes to reducing strain on the on-call team.
Further work is being done to reduce the number of patients presenting through the SAU pathway, and preferentially attending through ESAC.
O-L09 Determining the Prognostic Utility of Immuno-histochemically detected Trans-membranous Human Equilibriative Nucleoside Transporter 1 (hENT1) in Patients Undergoing Hilar Cholangiocarcinoma Resection
Authors: Bird Nicholas , Manu Nichola , QuinnL Mark , Diaz-Nieto Rafa , Fenwick Stephen , Jones Robert , Malik Hassan 
Published: December 2021

Abstract

Background
Human equilibriative nucleoside transporter protein 1 (hENT1) is a trans-membranous protein which facilitates nucleoside transport in to the cell. Immunohistochemically-detected hENT1 abundance is increased in cholangiocarcinoma tumour cells compared to matched non-tumour cells and increased in highly metabolising cells. The privately-held Mackey 10D7G2 hybridoma has demonstrated prognostic utility in Pancreatic Ductal Adenocarcinoma patients. The commercially available Proteintech Polyclonal hENT1 antibody’s prognostic utility has not been previously assessed. Cellular Ki67 expression has been linked to mitotic indices of tumour proliferation. This proof-of-concept study aims to assess the antibodies prognostic utility for hilar cholangiocarcinoma patients undergoing surgical resection.

Methods
Between February 2009 and February 2016 54 patients underwent resection for peri-hilar cholangiocarcinoma. Formalin-Fixed Paraffin Embedded (FFPE) blocks from a sub-set of 44 resected specimens were retrieved. Appropriate areas of tumour were sampled from the blocks and a Tissue-Matched Array (TMA) was constructed. The TMA underwent staining for each antibody. H-scores were utilised to determine intensity of expression. Correlation of expression between antibodies was determined by Pearson correlation co-efficient and Chi-squared where appropriate. Silencing RNA transfected HepG2 cell-lines was used to determine hENT1 staining by the Proteintech antibody. Demographic and survival characteristics for the patients were acquired from a prospectively held database linked to Hospital Episode Statistics. Survival characteristics were calculated with global log-rank calculations.

Results
There was significant correlation between the Mackey 10D7G2 and the Proteintech antibodies (p &lt; 0.001). There was significant correlation between the Proteintech hENT1 antibody expression and Ki67 expression (p = 0.02). Knockdown of hENT1 with silencing RNA transfected HepG2 cells was confirmed by Western blot in a time-dependent fashion over 72 hours. The antibodies (Mackey; Proteintech; Ki67) did not achieve significance for predicting OS (p = 0.75; 0.63; 0.22 respectively). Nodal stage (p = 0.03) and grade of tumour differentiation (p = 0.02) were the univariate tumour variables with prognostic utility.

Conclusions
While the Proteintech antibody demonstrates concordance with the 10D7G2 antibody in determining hENT1 expression the antibodies did not demonstrate significant prognostic ability in this proof-of-concept study. Standard histopathological co-variates retain prognostic utility within the cohort.
O-OGC01 Development and validation of multivariate prediction model of long-term survival after oesophagectomy in patients with oesophageal cancer
Authors: Gujjuri Rohan R , Clarke Jonathan M , Elliot Jessie A , Reynolds John V , Markar Sheraz R ,   ENSURE Study Group
Published: December 2021

Abstract

Background
Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can help clinicians identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed and evaluated a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer.

Methods
Patients who underwent curative surgery between June 2009-2015 from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and Random Survival Forest (RSF). Model performance was evaluated using discrimination (time-dependent area under the curve (tAUC)) and calibration (visual comparison of predicted and observed survival probabilities).

Results
This study included 4719 patients with an OS of 47.7% and DFS of 48.4% at 5 years. Sixteen variables were included in the final model. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% (95% CI 77.4-79.1%) and 77.1% (95% CI 76.1-78.1%) for OS and a tAUC of 79.4% (95% CI 78.5-80.2%) and 78.6% (95% CI 77.5-79.5%) respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20-80% and moderate agreement in the &lt;20% and &gt;80% quintile groups.

Conclusions
This study demonstrated the ability of a statistical model to accurately predict long-term survival and time-to-recurrence after surgery for oesophageal cancer, with CPH and RSF models showing good discrimination and calibration. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by enhancing selection of treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to improve understanding of the clinical utility derived from prognostic model use.
O-OGC04 Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of Esophago-gastric junctional adenocarcinomas: A 10-year cohort study
Authors: Elshaer Ahmed , Wijeyaratne Manuk 
Published: December 2021

Abstract

Background
Esophago-gastric junctional (EGJ) cancers have been considered recently as distinct tumour entity with characteristic genetic profiles. However, the optimal multimodal therapy of advanced EGJ cancers is still debatable. In this comparative study, we analysed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced EGJ adenocarcinomas.

Methods
This study included patients with locally advanced but resectable EGJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019, at our institution. Follow up till May 2021 was done. The outcomes between CT and CRT groups were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases.

Results
107 patients had EGJ cancers; 90 (84%) patients met our inclusion criteria. Peri-operative chemotherapy was received in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups.

Conclusions
Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for EGJ adenocarcinomas compared to peri-operative chemotherapy, without increase in postoperative complications or morbidity rates. However, it wasn’t associated with improved overall or disease-free survival rates. These findings supported the use of CRT in treatment of advanced EGJ adenocarcinomas.
O-OGC05 Every veneSection Counts – can we improve patient experience in high-risk upper gastointestinal surgery patients?
Authors: Bentley Richard , Ireland Edward , Griffiths Nathan , Beharall Bethan , Paul Barry , Pennington Jane de , Browell Christopher 
Published: December 2021

Abstract

Background
Patients with upper gastrointestinal (UGI) malignancy undergo major surgical resections resulting in significant postoperative inpatient stays. Central venous access is utilised to aid management of intraoperative physiology, immediate post-operative care and perioperative complications, which are often complex. Central venous catheters (CVC) and peripheral intravenous (IV) cannulae have a relatively short safe duration; consequently these patients undergo numerous unpleasant venous access attempts.
Our aim was to optimise quality of care and patient satisfaction in this high-risk patient group, by inserting Peripherally Inserted Central Catheters (PICCs) pre-operatively to facilitate administration of intravenous (IV) medications, fluids and perioperative blood sampling.

Methods
We reviewed venous access management in this group from October 2019 to May 2020;recording numbers of IV cannuale, CVCs and any associated complications. From September 2020, all patients deemed high-risk, undergoing a major UGI resection were offered a PICC, inserted pre-operatively. We recorded data on use of CVCs and alternative venous access devices, peripheral venous stabs, complications and overall patient experience.

Results
Over the first 6 month period we sited 30 PICCs - significantly fewer patients required a perioperative CVC (9% vs 64%) in the PICC group and these lines remained in situ for much longer than CVCs (mean 17 days vs 4.7 days). The PICC group required fewer peripheral cannulae (mean 2.73 vs 5.95 per patient). One patient suffered deep vein thrombosis (DVT) but there were no other adverse consequences. Two patients (9%) were treated for fast ventricular response to Atrial Fibrillation successfully on their surgical ward, with IV Amiodarone via their PICC, negating need for critical care admission. Patients in the baseline study required peripheral stabs for blood sampling most days of their inpatient stay (median 12.5 days), whereas the majority of samples were taken from PICCs in the post-intervention group. Satisfaction scores were high in 100% of cases.

Conclusions
The introduction of PICCs in our high-risk UGI patients has been a huge success, positively influencing the patient journey. There are demonstrable outcome benefits with reduction in CVCs, peripheral cannulations and phlebotomy attempts. In addition, it has facilitated easier and timelier perioperative administration of IV fluids and medication, optimising patients’ experiences and care.
O-OGC08 The Impact of Anastomotic Techniques on Post-operative Anastomotic Complications: Results of the Oesophago-Gastric Anastomosis Audit (OGAA)
Authors: Bundred James ,   Oesophago-Gastric Anastomosis Audit on Behalf of WMRC
Published: December 2021

Abstract

Background
The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage (AL) and conduit necrosis (CN) are not known. The aim of this study was to assess whether anastomotic technique is associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit (OGAA) cohort.

Methods
This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over nine months in 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled or circular stapled. The primary outcome was a composite of AL and CN, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modelling was used to identify the strength of association between anastomotic techniques and anastomotic failure.

Results
Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0% and circular stapled in 51.9%. Anastomotic techniques differed significantly between the anastomosis site (p &lt; 0.001), with the majority of neck anastomoses being handsewn (69.9%), whilst most chest anastomoses were stapled (66.3% circular stapled, 19.3% linear stapled). Rates of AL/CN differed significantly between the anastomotic techniques (p &lt; 0.001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled, and 12.1% in circular stapled. This was confirmed by multivariable analysis (Odds ratio (OR): 0.63, 95% CI: 0.46 - 0.86) for circular stapled vs. handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with AL/CN rates of 23.2% vs. 14.6% vs 5.9% for handsewn vs. linear stapled anastomoses vs circular stapled, compared to 13.7% vs. 13.8% vs 12.2% in chest anastomoses.

Conclusions
Handsewn anastomoses appear to be associated with higher rates of anastomotic failure for anastomoses in the neck. However, anastomotic failure rates in the chest were similar across techniques and there was no significant difference on multivariable analysis. Further research into standardization of approach and techniques may further improve outcomes.
O-P04 Sonodynamic Therapy Complements PD-L1 Immune Checkpoint Inhibition in a Murine Model of Pancreatic Cancer
Authors: Nesbitt Heather , Logan Keiran , Thomas Keith , Callan Bridgeen , Gao Jinhui , Kaig Thomas Mc , Taylor Mark , Love Mark , Stride Eleanor , Hale Anthony Mc , Callan John 
Published: December 2021

Abstract

Background
The emergence of immune checkpoint inhibitors (ICI’s) in the past decade has proven transformative in the area of immuno-oncology. The PD-1 / PD-L1 axis has been particularly well studied and monoclonal antibodies developed to block either the receptor (anti PD-1) or its associated ligand (anti PD-L1) can generate potent anti-tumour immunity in certain tumour models. However, many “immune cold” tumours remain unresponsive to ICI’s. Sonodynamic therapy (SDT) is a targeted anti-cancer treatment that uses ultrasound to activate a sensitiser with the resulting generation of reactive oxygen species (ROS) causing direct cell death. SDT has also been shown to stimulate the adaptive immune system in a pre-clinical cancer model. We investigate the ability of combining ICI and microbubble mediated SDT at controlling tumour growth in a bilateral pancreatic cancer model.

Methods
Preparation of O2MB-RB are shown below (scheme 1). Cytotoxicity of SDT and immunotherapy in-vivo are illustrated below (Figure 1). Figure 1 highlights that T110299 cells were subcutaneously implanted in the right and left dorsum of C57 mice. Group 1 received an IP injection of anti-mouse PD-L1 antibody (10mg/kg). After 2 hours, mice in this group received an IV injection of O2MB-RB suspension while receiving ultrasound applied to the right-hand-side (target) tumour. Group 2 received the same as Group 1 but no anti PD-L1 antibody; Group 3 received anti-PD-L1 antibody alone and Group 4 remained untreated. Flow cytometry analysis were carried out to investigate tumour infiltrating CD4+ and CD8+ T-lymphocytes.

Results
The results demonstrated a significant 287% decrease in tumour volume when compared to untreated animals 11 days following the initial treatment with SDT, which reduced further to 369% when SDT was combined with anti-PD-L1 ICI treatment. Analysis of residual tumour tissues remaining after treatment revealed increased levels of infiltrating CD4+ and CD8+ T-lymphocytes (respectively 4.65 and 3.16-fold more) in the off-target tumours of animals where the target tumour was treated with SDT and anti-PD-L1, when compared to untreated tumours. These results suggest that SDT treatment elicits an adaptive immune response that is potentiated by the anti-PD-L1 ICI in this particular model of pancreatic cancer.

Conclusions
In conclusion, microbubble mediated SDT treatment of a target tumour in a bilateral tumour model of pancreatic cancer, enables growth control at both the target and off-target tumours which is further enhanced when combined with anti-PD-L1 ICI treatment. Combining SDT with anti-PD-L1 ICI treatment, which is also well tolerated, could provide an attractive treatment option for pancreatic cancer, particularly for patients with advanced disease who may not be physically capable of undertaking a toxic chemotherapy regimen.