bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP8.1.7 Sentinel Lymph Node Biopsy or Neoadjuvant Chemotherapy- What comes first?
Authors: Karki Smriti , Hassen Yasmin , Chakravorty Arunmoy , Ajauskaite Karolina , Babu Ekambaram Dinkara 
Published: October 2021

Abstract

Aims
NICE guidelines have not defined the timing of Sentinel Lymph Node Biopsy (SLNB) with respect to neoadjuvant chemotherapy (NACT). While there is an ongoing debate, the emerging consensus is in favour of SLNB following NACT in clinically node-negative (cN0) patients which confers the advantage of better prognostic outcomes as a negative SLNB negates further Axillary Lymph Node Dissection (ALND) and prevents patients having further unnecessary surgery.
Thus, the aim of the study was to establish whether unnecessary ALND can be safely avoided by performing SLNB after NACT.

Method
Retrospective case records review of all patients treated with ALND at a single institution was undertaken from January 2018 to December 2019.

Results
73 patients had ALND in this time frame.
Patients received SLNB before NACT and ALND was performed if they were found node-positive on SLNB.
Out of 73 patients, 24 patients had no further nodal disease, 26 had 1-2 macrometastasis and 23 had 3 or more macrometastasis on ALND.
57/73 patients had early breast cancer (T1/T2). 21/57 were cN0 but and 5/21 had NACT following SLNB and ALND after NACT.
Of the 5 patients, 2 (40%) had no nodal disease on ALND.

Conclusion
40% patients could have avoided ALND if SLNB was done after NACT. Also, 68% (50/73) patients who had ALND only had &lt;2 lymph node macrometastasis. This data implies that patients with early breast cancer may be getting subjected to a second operation which not only is unnecessary but also may have debilitating complications.
SP9.1.2 Sarcopenia and myosteatosis predict thirty-day emergency laparotomy mortality [The FrOGS study]
Authors: Body Samantha , Ligthart Marjolein , Ward James , Pucher Philip H , Curtis Nathan , West Malcolm 
Published: October 2021

Abstract

Aims
Sarcopenia (low muscle mass - SM) and myosteatosis (low muscle quality - SM-RA) are associated with poor outcomes after elective cancer surgery. Body composition parameters have not been explored in emergency surgery and may offer additive value to risk prediction scores. This multicentre study assessed the association of body composition and survival after emergency laparotomy.

Methods
A retrospective longitudinal cohort of 674 patients, across 10 hospitals in southern England were recruited (NCT03534765). All patients underwent emergency laparotomy, fulfilling NELA criteria, between August 2016 and November 2017. Pre-operative CTs were blindly analysed using L3 slices, assessing SM and SM-RA. Regression analysis was used to assess associations of body composition and 30-day mortality.

Results
Six hundred and ten patients were included [283(46%) men, median(IQR) age 71 years (57-79)]. P-POSSUM and NELA predicted mortality was 7% and 4.5% respectively, with a length of stay of 15 days (9-24), 30-day mortality of 7.8% and 1-year mortality of 18.9%. Significant univariate associations between 30-day mortality and age (OR1.04 (1.02-1.07);p=0.001), Charlson score (OR 6.84 (1.64-28.55);p=0.008), P-POSSUM (OR 1.03 (1.02-1.05);p&lt;0.001, NELA mortality (OR 1.06 (1.04-1.08);p&lt;0.001), SM (OR 0.98 (0.97-0.99);p=0.003 and SM-RA (OR 0.93 (0.9-0.96);p&lt;0.001. Significant multivariate associations between 30-day mortality and NELA (OR 1.05 (1.03-1.07); p &lt; 0.001, P-POSSUM (OR 1.03 (1.01-1.04); p &lt; 0.001, SM-RA (OR 0.94 (0.9-0.97); p &lt; 0.001.

Conclusions
Sarcopenia and myosteatosis are associated with increased mortality in patients undergoing emergency surgery. Body composition should be considered as an objective adjunct to traditional risk assessments, further informing the shared-decision making process around emergency surgery.
SP10.2.1 Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills
Authors: Edgar Ben , MacDonald Scott , Stokes Emily , McDade David , John Anderson , Angus Macdonald 
Published: October 2021

Abstract

Aims
The use of endoscopic simulators as a learning aid in surgical training has been well established, particularly in those with less experience. In the challenging time of COVID-19, when endoscopic procedures are at a minimum, this can become more valuable. However, their utility for training is countered by the high cost of equipment.
We demonstrate a cost-efficient alternative to traditional endoscopy simultators, which can be easily made in any centre.

Methods
A polypectomy simulator model was created using a drain-pipe and surgical gloves. Junior doctors were timed in their ability to remove the 3 polyps from within the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA.

Results
There was a mean relative reduction of 75% in overall time taken to complete the task (p &lt; 0.0001). This improvement was seen for both surgical trainees with previous endoscopy experience (p = 0.005) and FY1 novices (p &lt; 0.0001).

Conclusions
In our group, we have seen improvement in performance across both surgical trainees and novices. In today's era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy.
This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training.
SP10.2.2 Improving undergraduate surgical education: Comparing findings from the ASiT consensus report with the RCS Undergraduate Surgical Curriculum and GMC Outcomes for Graduates
Authors: Deekonda Praveena , Baker Daniel , Nally Deirdre , Srikandararajah Nisaharan , Humm Gemma ,   ASiT Medical Student and Junior Doctors Consensus Group
Published: October 2021

Abstract

Aims
Previous work by ASiT has shown that undergraduate years can have a significant impact on the decision to pursue a surgical career. The Royal College of Surgeons England launched their recommendations in the undergraduate surgical curriculum in 2015. Our aim was to ascertain whether any additional areas of importance could be highlighted.

Methods
A consensus document was developed, using the RCS undergraduate surgical curriculum and GMC Outcomes for Graduates as baseline guides. An external advisory group made additional recommendations for inclusion which was then presented and discussed at a face-to-face consensus session at the 2019 ASiT International Surgical Conference. A consensus threshold of 80% was accepted.

Results
A total of 69 ‘core’ topics were reviewed and discussed, of which 10 did not reach consensus. These topics were predominantly considered to be ‘specialist’ in nature, and were under the domains of Head and Neck/ENT, neurosurgery, paediatric or vascular surgery. Of note, knot tying, which is included in the GMC guidance, was considered beyond the required level of a graduate and more suitable for those with the interest or intent to pursue a career in surgery.

Conclusions
Our consensus meeting and subsequent report has highlighted differences between the current available guidance and what medical students and junior doctors consider to be ‘core’ undergraduate surgical knowledge and skills. Topics that did not meet consensus may form areas of need in early postgraduate training. Our findings should be used in addition to the RCS and GMC guidance for undergraduate surgical education.
TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins
Authors: Balasubramanian Ashok , Gambhir Raghvinder , Rashid Hisham 
Published: October 2021

Abstract

Aims
The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure.

Method
Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet.

Results
A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure.
247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others.
40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure.

Conclusion
OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.
TP5.2.4 Patency of radiocephalic versus brachiocephalic arteriovenous fistula in a major tertiary hospital
Authors: Wong Fui Lin , MacAulay Ewan , Hussey Keith 
Published: October 2021

Abstract

Introduction
The patency of brachiocephalic fistulae is generally considered to be superior to radiocephalic fistulae. We have explored this in a major tertiary hospital.

Method
This was a retrospective review of fistulae created between 1st January 2015 and 31st July 2020. Index cases were identified from a prospectively maintained vascular access database. Patient demographics, procedure details and subsequent interventions are described.

Results
There were 915 fistulae created on 813 patients (528 males and 285 females). There were 388 radiocephalic fistulae created on 374 patients and 363 brachiocephalic fistulae were formed on 301 patients. Both groups had 315 fistulae with patency data available. Age and a diagnosis of diabetes were comparable. There were significantly fewer female patients in the radiocephalic cohort (p = 0.004). Primary patency at 3 months, 1 year and 3 years were 84.6%, 58.1% and 37.9% for radiocephalic and 87.9%, 63.1% and 37.0% for brachiocephalic fistula (p = 0.273). Primary assisted patency at 3 months, 1 year and 3 years were 92.3%, 87.0%, 77.4% for radiocephalic and 96.1%, 88.6%, 79.9% for brachiocephalic fistulas (p = 0.295). Secondary patency at 3 months, 1 year and 3 years were 93.3%, 88.3% and 81.5% for radiocephalic fistulas and 97.4%, 90.6% and 85.7% for brachiocephalic fistulas (p = 0.134).

Conclusion
We have demonstrated similar primary, primary-assisted and secondary patency for radiocephalic and brachiocephalic fistulae. Pre-operative ultrasound vein mapping, selective ultrasound surveillance, surgical expertise and careful patient selection may contribute to the high secondary patency and absence of difference between the groups.
TP5.2.18 Should follow up to bariatric surgery be extended beyond 2 years for patients with concurrent renal disease?
Authors: Stephenson Josh , Yokum Dawn , Durman Katie 
Published: October 2021

Abstract

Aims
Following bariatric surgery, all patients must be offered a minimum follow up period of 2 years to support patients with potential early and long-term post-operative complications. Patients with end-stage renal disease may need extra support for extended period as micronutrient homeostasis may be impaired long term due to reduced kidney function.
This study aims to analyse micronutrient homeostasis of patients with concurrent renal disease and post-op bariatric surgery, to determine need for an extended minimum follow up period.

Methods
The study was performed in a single referral centre between 2009-2021 and the data was collated from a prospectively collected database. All patients included must have concurrent renal disease and bariatric surgery and followed up for at least 3 years. In addition to clinical variables, micronutrient and metabolic data were collected and analysed.

Results
A total of 35 patients were included in this study. Micronutrient homeostasis difficulties were recorded in 32 of the 35 patients. Specific micronutrients that were affected includes: vitamin A, B12, folate, ferritin, copper, zinc, selenium, calcium and magnesium. All micronutrient instabilities lasted a period of at least 3 years without a renal transplant.

Conclusion
Data from this study suggests that patients post bariatric surgery with concurrent renal disease have difficulties maintaining micronutrient homeostasis. This suggests that extending the minimum follow up period and may be necessary to avoid pathological sequalae from micronutrient excess and or deficiency.
TP6.1.3 Bayesian Network Meta-Analysis of Upfront Surgery versus Neoadjuvant Therapy for Potentially Resectable Pancreatic Ductal Adenocarcinoma
Authors: Bradley Alison , Van Der Meer Robert , McKay Colin 
Published: October 2021

Abstract

Aims
To compare upfront surgery and neoadjuvant treatment strategies for potentially resectable PDAC.

Methods
PubMed, MEDLINE, Embase, Cochrane Database and Cochrane Databases were searched for studies comparing neoadjuvant and upfront surgery. A Bayesian network meta-analysis was conducted using the Markov chain Monte Carlo method to better handle the heterogeneity of existing studies. Convergence was assessed using the Brooks-Gelman-Rubin method. In accordance with NICE guidelines inconsistency was measured by comparing deviance residuals and DIC statistic in fitted consistency and inconsistency models. Cochrane Collaboration’s risk-of-bias, ROBINS-I and GRADE tools were used to assess the quality of included trials.

Results
25 studies were included (n = 32,921). Aggregate rate (AR) of R0 was marginally higher with neoadjuvant therapy (0.7389 versus 0.7306, O.R 1.12, 95% CI 0.60-2.08). AR of 1,2,3,4 and 5-year survival were higher with neoadjuvant therapy (1-year survival: 0.8109 versus 0.6403, O.R: 2.12, 95% CI: 1.59-2.93; 2-year survival: 0.5135 versus 0.3002, O.R: 1.65 95%, CI: 1.16-2.34; 3-year survival: NAT 0.3151 versus 0.2147, O.R: 1.50, 95% CI: 1.10-2.04; 4-year survival: 0.2114 versus 0.1647 O.R: 1.57, 95% CI: 0.80-2.99; 5-year survival: 0.2118 versus 0.1736, O.R: 1.65, 95% CI: 0.68-3.73). Multimodal treatment was the key determinant of optimal outcome.

Conclusion
Considering the flaws in the existing evidence neither treatment pathway is conclusively superior at population level analysis. Receipt of multimodal treatment at individual level within either pathway optimises outcomes. This study demonstrates the importance of developing statistical methods that better engage with system complexity and uncertainty to move towards more personalised predictive medicine to support decision-making.
TP6.2.2 Multi-disciplinary interventions to increase utilisation of NELA scores and critical care involvement following emergency colorectal surgery
Authors: Smith Scott , Hodge Katherine , Ying Andrew , Swan Rebecca , Von Maydell Alexander , Ventham Nicholas 
Published: October 2021

Abstract

Aims
This audit aimed to assess pre-operative NELA risk score documentation and subsequent specialist peri-operative critical care involvement.

Methods
This complete audit cycle retrospectively reviewed notes (electronic patient records, anaesthetic charts and CEPOD booking forms) of all patients undergoing emergency laparotomy between March and May 2019. The NELA score was calculated retrospectively if not documented. Following the initial audit, the following multi-disciplinary interventions were instituted: alteration of the physical CEPOD booking form to include NELA score (Surgical); a sticker added to anaesthetic charts to prompt NELA calculation (Anaesthetic), formal recording of NELA score during theatre brief (Theatre staff); and by increasing awareness of NELA via departmental education (All). The audit cycle was completed by reassessment between October and November 2020.

Results
The initial cycle included 34 patients, with only 2 (6%) having a NELA documented. The repeat cycle included 35 patients, with 29 (83%) having a NELA documented. Regarding post-operative critical care admissions, both cycles found that 100% of patients with a NELA of ≥ 5%, were admitted to either surgical HDU or ICU (n = 17 in first cycle, n = 17 in second cycle). For those with a high-risk NELA of ≥ 10% (n = 11 in first cycle, n = 7 in second cycle), only 2 (18%) were admitted to ICU in the first cycle vs 7 (100%) in the second cycle.

Conclusions
This complete audit cycle demonstrates improved NELA score calculation following institution of several multidisciplinary interventions. The improved NELA score uptake was associated with increased critical care review and admission to ITU in high-risk cases.
TP6.2.6 A meta-analysis and systematic review of Laparoscopic versus open hepatectomy for malignant liver tumours in the elderly patients
Authors: Mohamedahmed Ali Yasen Y , Zaman Shafquat , Albendary Mohamed , Wright Jenny , Mankotia Rajnish , Sillah Abdul Karim 
Published: October 2021

Abstract

Aims
To evaluate comparative outcomes of laparoscopic versus open hepatectomy for malignant liver tumours in elderly patients.

Methods
A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing laparoscopic (LH) versus open hepatectomy (OH) for both primary and metastatic malignant liver tumours in the elderly were included. Total operative time (minutes), need to perform Pringle’s manoeuvre, blood loss (ml), requirement for blood transfusion intra-operatively/post-operatively, post-operative complications, R0 resection rate, specimen resection margin (mm), re-operation rate, length of hospital stay (LOS), and 90-day mortality were the evaluated outcome parameters.

Results
Twelve studies reporting a total number of 1762 patients who underwent laparoscopic (n = 831) or open (n = 931) hepatectomy were included. OH group was associated with a significantly higher number of post-operative complications compared to LH (P = 0.00001). Complications such as post-operative liver failure (P = 0.02), ascites formation (P = 0.002), surgical site infection (P = 0.02), blood loss (P = 0.03), blood transfusion rate (P = 0.05) and LOS (P = 0.00001) were significantly higher in the OH group when compared to LH. There was no significant difference between the two groups in terms of total operative time (P = 0.53), bile leak (P = 0.12), R0 resection rate (P = 0.36), re-operation (P = 0.70) and 90-day mortality (P = 0.11).

Conclusion
Laparoscopic liver resections are safe with at least equal or superior peri-operative outcomes in the elderly population. Importantly, oncological outcomes are also comparable with open surgery. This approach needs to be utilised wherever possible to provide optimal healthcare in an aging population.
TP6.2.14 Outcome of POEM (Per-oral endoscopic myotomy) for achalasia
Authors: White Annabelle , Hwang Woochan , Kotta Alekhaya , Beasley Daniel , Chow Katarina , Botha Abraham 
Published: October 2021

Abstract

Aims
Laparoscopic Heller’s myotomy (LHM) has been the surgical gold standard for treatment of oesophageal achalasia. Peroral endoscopic myotomy (POEM) has been proposed as an alternative technique. The aim of this study was to assess the safety and efficacy of POEM for achalasia in our unit.

Methods
We have operated on 202 patients for oesophageal achalasia since 2005: 107 had LHM, 86 had POEM, and 9 had an oesophagectomy. We assessed the clinical outcome of POEM comparing pre- and postoperative endoscopic, radiologic and manometric findings, as well as Eckardt-, GERD- and DsQoL score for achalasia. All follow-up patients were offered endoscopy.

Results
Data were completed for the first 45 POEM patients. The average age was 45 years. 18 patients (40%) had prior achalasia treatment. The median hospital stay was 2 days (2-5). There was no mortality, but 4 patients (9%) had post-operative complications. The median follow-up was 24 months (12-49). Clinical success (Eckardt score ≤ 3) was achieved in 39 patients (87%). Thirteen patients (29%) were taking PPIs for chest symptoms. Eleven of these underwent pH studies of whom only 1 had a DeMeester score &gt; 14.5. Of the 24 patients who had post-operative endoscopy, 40% was diagnosed with oesophagitis grade A, yet only 5 of them were symptomatic.

Conclusions
POEM appears to be safe and effective and warrants consideration as first-line therapy in expert achalasia centres. Longer term randomized studies comparing the outcomes of POEM with LHM and pneumatic dilatation will determine its place in the treatment of achalasia.
TP6.2.15 Staging Laparoscopy and Peritoneal Cytology for Gastric and Gastro-oesophageal Junction Malignancy: an Audit from a Single Oesophagogastric Resection Centre
Authors: Clements Hollie Alice , Rupasinghe Sukitha Namal , Alam Mushfique , Murphy Kieran , Rao Rohith 
Published: October 2021

Abstract

Aims
AUGIS recommends staging laparoscopy in all gastric cancers and selected gastro-oesophageal junction (GOJ) cancers. We previously audited our practice of staging laparoscopy and peritoneal cytology and found that in a cohort of 158 consecutive patients, no tumours less than T3 with negative nodes had positive cytology, resulting in change in practice to selectively use peritoneal cytology in patients with a T-stage of 3 and above or N+ disease. Our aim was to assess the impact of this audit on current practice.

Methods
We retrospectively reviewed the notes of patients undergoing staging laparoscopy and oesophagogastroduodenoscopy (OGD) identified by MDT from January 2019 to December 2019. Patients who underwent resection on the same day were excluded.

Results
63 patients underwent staging laparoscopy and OGD, 54 for GOJ and 9 for gastric disease. The majority were staged as T3 or T4a (81%). As a result of staging laparoscopy and OGD, 4 (6%) patients were changed from curative to palliative pathway, 2 (3%) of whom had positive cytology. No patients had positive peritoneal cytology for a T stage of 2 and below with no positive nodes, further demonstrating the safety of the recommendation.

Conclusions
Peritoneal cytology has a low yield in changing the clinical course of patients but can upstage up to 6% of patients. The re-audit backs up the previous guidance in the safety of using our current threshold for recommending peritoneal cytology and potentially prevents delaying treatment while waiting for cytology results.