bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP4.2.10 COVID-19 and General Surgery in a District General; Safety and Quality data
Authors: Fifer Helen , Hussain Muhammad Ibrar , Grey Tamsyn , Saha Arin , Peter Mark 
Published: October 2021

Abstract

Aim
The Covid-19 pandemic forced departments to change standard modes of delivery of care. Within our unit, reductions in junior workforce and changed operating protocols resulted in greater consultant presence on in-patient wards and the ambulatory unit. This study aimed to determine the effect on patient outcomes by interrogation of data collected from weekly Safety and Quality Clinical Governance meetings.

Methods
Patients admitted between December 2019 and February 2020 were compared to those admitted between April 2020 and June 2020. The weekly meeting mandates consultant discussion of all readmissions, all patients who had a length of stay (LoS) of &gt; 7 days and all admissions to critical care. Outcomes between the two time periods were compared.

Results
There was a marked reduction in admissions during the second study period. However, the proportion of patients discharged from ambulatory care increased as did the proportion of readmissions; in the pre-Covid period, there were 429 readmissions of which 188 (44%) were unplanned but in the post-Covid period, there were 311 readmissions. There were no serious adverse events from discharged patients or readmissions.
There were markedly fewer patients who had a LoS &gt; 7days (179 patients versus 87) and a greater number of unplanned admissions to critical care (44% versus 64%).

Conclusions
Increased consultant presence may explain the reduced LoS and increased readmissions due to the greater ‘risk’ that senior clinicians are prepared to take. Enhanced consultant presence should be a permanent change, even after the pandemic is over.
SP4.2.12 The impact of COVID 19 on colorectal cancer diagnosis and surgical oncological provision; A national perspective
Authors: Donlon Noel , Nugent Tim , Irwin Shane , Ramjit SInead , Davern Maria , Mealy Ken 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic has interfered with many aspects of cancer management, including delayed diagnoses, stalled screening programmes, limiting treatment and clinical trials. Colorectal cancer is the second commonest cause of cancer death in Ireland. The objective of the current study is to assess the impact of this pandemic on colorectal cancer diagnoses and surgery, at a national level.

Methods
Data on endoscopy, emergency and elective colorectal operations nationally in Ireland over a three year period (2018-2020) were obtained from the National Quality Assurance Improvement System. Data relating to cancer surgery only were included and patient demographics, type of surgery (open/laparoscopic), length of stay (LOS), mortality, admission to critical care and re-admission rates were collected and analysed.

Results
31.33% less cancers have been diagnosed between March and November 2020 inclusive when compared to the same period over the past two years with 22% less rectal cancers identified. There has been a 34% reduction in colorectal cancer surgeries over the same period with a reduction of 42% at the initial wave during the period March-May and of concern, this trend has continued. Laparoscopic right hemicolectomies have reduced by 41%, anterior resections have reduced by 51% with no change in the number of temporary ileostomies over the three year period.

Conclusion
The impact of COVID-19 on colorectal cancer surgery nationally has been profound. The reduction in diagnoses and cancer surgery is concerning and may result in increased late or incurable stage disease as a consequence of late presentation and diagnosis.
SP5.1.5 Bariatric surgery is associated with greater survival and metabolic health benefits than conventional medical management in people with NAFLD
Authors: Muir Duncan , Dempster Niall , Sgromo Bruno , Gillies Richard , Cobbold Jeremy , Tomlinson Jeremy 
Published: October 2021

Abstract

Aims
Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of the metabolic syndrome.There are no licensed pharmacotherapies for NAFLD, and it is rapidly becoming the leading cause of liver failure worldwide.Bariatric surgery (BS) is an effective and durable intervention for weight loss and type 2 diabetes (T2D) but is not recommended in the UK’s NICE guidelines for NAFLD management.We aimed to determine whether BS was associated with NAFLD regression.

Methods
1067 people with NAFLD were included in this observational cohort study.Liver histology/validated non-invasive biomarkers were used to diagnose NAFLD.Markers of liver and metabolic health were recorded longitudinally for participants undergoing hepatology-led (n = 702) or BS (n = 365) management in a UK tertiary centre. 1-year outcomes were compared using mixed models. 5-year mortality was compared using Cox proportional-hazards regression.

Results
T2D prevalence was similar between cohorts (p = 0.06). Differences in other baseline factors were observed (age, gender, and body mass index (BMI), all p &lt; 0001). BS showed a significantly lower adjusted 5-year mortality (p = 0.02). Both interventions were associated with improved biomarkers of liver health e.g. ALT (p = 0.00). Greater improvements in targets of NAFLD management such as HbA1c (p = 0.00) and BMI (p = 0.00) were observed after BS.

Conclusions
BS showed an improved 5-year survival compared to hepatology-led management. This may be explained by greater improvements in key targets for NAFLD regression in the BS cohort. However, residual confounding despite adjusted survival analysis cannot be excluded. A prospective randomised trial is recommended to ensure fair comparison of these interventions and enhance the clinical management of NAFLD.
SP5.1.8 Long term outcomes of laparoscopic magnetic sphincter augmentation for gastro-oesophageal reflux disease: High patient satisfaction with low dysphagia rates
Authors: Tabbakh Yasmin , Walsh Caoimhe , Tan Tai Joum , Nehra Dhiren 
Published: October 2021

Abstract

Aims
Laparoscopic magnetic sphincter augmentation (MSA) or LINX® procedure is gaining popularity as a treatment for gastro-oesophageal reflux disease. We looked at the long-term outcomes of this procedure with regards to its efficacy, in particular studying the dysphagia rate in relation to the LINX® device size.

Methods
Postal questionnaires were sent to all patients who underwent MSA procedure between 2012-2019 at a single institution. Patients were asked to quantify, as a percentage, their symptom resolution, proton pump inhibitor (PPI) intake and side effects.

Results
124 patients (male:female ratio was 45:55) underwent MSA procedure, with 82 responding to the questionnaire. Patients' age range was 18-71 years (median 49). Over 90% of patients reported improvements in reflux symptoms with 75% reporting complete resolution. 67% of patients no longer required PPI medication, whilst 21% of patients had &gt;50% reduction in their medication. Post-operative dysphagia occurred in 59% of patients at 3 months, which decreased to 16% at 1 year. There was no significant difference in size of LINX® device used between patients with dysphagia at ≥ 1 year versus those without dysphagia at ≥ 1 year (p = 0.554). In total 3 patients (2%) required explantation of the LINX® device. Overall 86% of patients rated their outcomes as satisfactory or very satisfactory.

Conclusions
Our 7 years of experience with laparoscopic MSA has demonstrated that this procedure is safe with high patient satisfaction rates. Dysphagia, although common in the early post-operative period, usually resolves within 3-6 months and is unrelated to LINX® device size.
SP5.1.9 Why are curative treatment rates so low for stage I/II Oesophago-gastric cancer in the West of Scotland?
Authors: Khan Khurram , Gall Lewis , Forshaw Matthew 
Published: October 2021

Abstract

Aims
Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment.

Methods
The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2018 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analysed.

Results
81 patients (mean age of 79.3 ± 8.9 years; 41 (50.6%) female) were identified. Median Scottish Index of Multiple Deprivation was 3 (IQR 1-7). There were 46 (56.8%) oesophageal cancers, 49 (60.5%) adenocarcinomas and 63 (77.8%) were Stage II cancers. Formal CPEX fitness was assessed in only 6 patients (7.4%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 69 (85.2%)); patient declined curative treatment (n = 7 (8.6%)); disease progression (n = 3 (3.7%)) and identification of synchronous cancers (n = 2 (2.5%)). 61 patients (75.3%) are deceased at the time of analysis, with a median time from MDT discussion to death of 6 (IQR 2-11.5) months.

Conclusions
Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.
SP5.1.11 The immune landscape of the Tumour draining lymph node and the Tumour Microenvironment in oesophageal; A novel therapeutic target
Authors: Donlon Noel , Davern Maria , Sheppard Andrew , Donohoe Claire , Reynolds John , Lysaght Joanne 
Published: October 2021

Abstract

Aim
The tumour microenvironment (TME) and tumour-draining lymph node microenvironment (LNME) remain poorly understood. Our study profiles the immune, angiogenic and inflammatory environment of the LNME and the TME of oesophagogastric patients.

Methods
The prognositc value of nodal status, clinical stage and tumour regression grade (TRG) was evaluated using a cohort of OAC patients (n = 702). Immune checkpoints (ICs) on tumour-draining lymph nodes(TDLNs, n = 6) and tumour tissue(n = 9) at surgical resection was assessed by flow cytometry. We also screened for cytokines, angiogenic mediators and chemokines. Using The Cancer Genome Atlas (TCGA), protein and mRNA levels (n = 72) and mutated versus non-mutated copies(n = 87) of this panel was correlated with survival.

Results
The frequency of CD3+TIM-3 and PD-1+T cells in TDLNs positively correlated with clinical tumour status as did CD8 + PD-1+TIGIT + T cells with nodal burden. Pro-angiogenic factor bFGF was significantly higher within the TME compared with the LNME. PIGF and SAA mediators of tumour growth were significantly higher in the LNME and levels of SAA in LNME positively correlated with adverse features. High levels of pro inflammatory IL-8,IL-6 and Flt1, mutations in pro-inflammatory genes CCL26,IL-31 and IL-17C and anti-tumour IL-1RN and CCL22 correlated with reduced overall survival.

Conclusions
The TME is more immunosuppressive than the TDLN, however, certain pro-angiogenic factors were enriched in TDLNs suggesting the priming of a pre-metastatic niche. Given the association of ICs with clinical features and tumour biology this may help to inform novel therapeutic approaches.
SP6.1.9 Colorectal Cancer and Synchronous Liver-limited Metastatic Disease: The final results of the CoSMIC Inception Cohort Study
Authors: Chan Anthony , Mason James , Siriwardena Ajith 
Published: October 2021

Abstract

Aims
Currently, evidence is inadequate to inform the selection of optimal treatment for patients with colorectal cancer and synchronous liver-limited hepatic metastases. Options include synchronous or staged surgery integrated with systemic chemotherapy. CoSMIC is the first inception cohort study to follow patients from point of presentation in order to identify factors influencing treatment and outcome.

Methods
Patients were identified at presentation to the regional liver metastases MDT at Manchester Royal Infirmary between April 2015-2018. Data were collected on demographics, intervention and outcome. The study was approved by Regional Ethics Committee (REC reference: 14/NW/1397).

Results
Of 125 patients recruited, 109 underwent surgery with 18 (17%) liver-first, 75 (69%) bowel-first and 16 (14%) undergoing synchronous resection. There were no differences in baseline demographics or co-morbidity. Eighty-eight completed the intended surgical pathway, with highest failure in liver-first patients where 39% did not proceed to subsequent bowel resection. Critical care occupancy between staged and synchronous resections (5.6 versus 5.2 days; P = 0.92), and inpatient stay (16.5 versus 16.8 days; P = 0.92) was not significant. There was no 30-day mortality. Cox regression analysis identified surgical sequence as a significant covariate (Х2= 31.3; P &lt; 0.001). Survival was similar between surgical groups (Log-rank test; P = 0.87).

Conclusions
CoSMIC is the first prospective inception cohort study of colorectal cancer and synchronous liver-limited metastasis. The study population is small and from a single centre and thus could be influenced by recruitment and sample bias. However, the important novel finding is that there is no survival difference between treatment pathways.
SP7.1.3 An integrated and upgraded meta-analysis of published randomized, controlled trials exploring the role of oral metronidazole as post-operative proctological analgesic agent
Authors: Rehman Saad , Hamid Moaz , Iqbal Karim , Ray Kausik , Sains Parv , Sajid Muhammad S 
Published: October 2021

Abstract

Aims
Proctological procedures such as haemorrhoidectomy have been reported with significant post-operative pain affecting quality of life as well as capacity to perform daily activities. The objective of this article is to explore the role of conventionally used antibiotic metronidazole as a proctological analgesic.

Methods
A systematic review of the randomized, controlled trials reporting the use of oral metronidazole as post-operative proctological analgesic agent in patients undergoing haemorrhoidectomy published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis.

Results
A total of eight randomized, controlled trials on 447 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of oral metronidazole as a post-operative proctological analgesic agent was significantly associated with the reduced pain score on day 1 (Standardized mean difference (SMD), -0.56; 95% CI, -1.04, -0.07; z = 2.26; P = 0.02), day 3 (SMD, -0.82; 95% CI, -1.33, -0.31; z = 3.15; P = 0.002) and day 7 (SMD, -1.48; 95% CI, -2.51, -0.45; z = 2.82; P = 0.005). There was significant heterogeneity (Tau2 = 0.39, chi2 = 38.38, df = 7, [p = 0.00001]; I2 = 82 %) among included studies.

Conclusion
The use of oral metronidazole as a post-operative proctological analgesic agent following haemorrhoidectomy seems to have proven clinical advantages and may routinely be used.
SP7.1.6 Using Diffuse Reflectance Spectroscopy (DRS) to Identify Tumour and Non-tumour Tissue in Upper Gastrointestinal Specimens
Authors: Nazarian Scarlet , Gkouzionis Ioannis , Anandakumar Arun , Patel Nisha , Elson Daniel , Peters Christopher 
Published: October 2021

Abstract

Aim
Cancers of the upper gastrointestinal (GI) tract remain a major contributor to the global cancer risk. Surgery aims to completely resect tumour with clear margins, whilst preserving as much surrounding tissue. Diffuse reflectance spectroscopy (DRS) is a novel technique that presents a promising advancement in cancer diagnosis. We have developed a novel DRS system with tracking capability. Our aim is to classify tumour and non-tumour GI tissue in real-time using this device to aid intra-operative analysis of resection margins.

Method
An ex-vivo study was undertaken in which data was collected from consecutive patients undergoing upper GI cancer resection surgery between August 2020- January 2021. A hand-held DRS probe and tracking system was used on normal and cancerous tissue to obtain spectral information. After acquisition of all spectra, a classification system using histopathology results was created. A user interface was developed using Python 3.6 and Qt5. A support vector machine was used to classify the results.

Results
The data included 4974 normal spectra and 2108 tumour spectra. The overall accuracy of the DRS probe in differentiating normal versus tumour tissue was 88.08% for the stomach (sensitivity 84.8%, specificity 89.3%), and 91.42% for the oesophagus (sensitivity 76.3%, specificity 98.9%).

Conclusion
We have developed a successful DRS system with tracking capability, able to process thousands of spectra in a small timeframe, which can be used in real-time to distinguish tumour and non-tumour tissue. This can be used for intra-operative decision-making during upper GI cancer surgery to help select the best resection plane.
SP7.1.11 Deprivation has No Effect on Oesophagogastric Cancer Outcomes in North of Scotland
Authors: Hunter Ross , Griffin Fiona , Nanthakumaran Shayanthan , Ramsay George 
Published: October 2021

Abstract

Introduction
Despite advances in medical therapies and surgical techniques, oesophagogastric cancer survival remains low. Poorer survival and outcomes from colorectal cancer have been reported for patients living in areas of higher socioeconomic deprivation1. Our aim was to determine if deprivation affected oesophagogastric cancer survival in North East of Scotland.

Methods
A prospective, single-centre observation study was conducted utilising data from oesophago-gastric cancer MDT referrals and outcomes from January 2013 to December 2019. Patient postcodes were cross-referenced with the Scottish Index of Multiple Deprivation (SIMD) 2020 tool which provided a level of deprivation for each address. Survival outcomes were compared across demographic factors, disease factors and stage at presentation across deprivation quintiles.

Results
1046 patients were included in this study. There were fewer patients in the most deprived (1st) quintile (n = 65) than in the least deprived (5th) quintile (n = 245). There was no significant difference between oesophageal versus gastric cancer presentations nor was there any difference between T, N or M stage at presentation between the most and least deprived groups. No difference was identified between those commenced on a radical therapy with other treatment plans. No difference in survival time was noted between the groups.

Discussion
No difference in survival was demonstrated across areas of deprivation within this catchment area. However, Aberdeenshire is an affluent area with less overall deprivation compared with other areas of Scotland.
SP7.1.13 Facial nerve morbidity after superficial parotidectomy in the absence of nerve conductor: a general surgeon experience from a low resource country
Authors: Dhahri Adeel Abbas , Hashmi Fazila , Akbar Muhammad , Akhtar Riaz , Dhahri Mehvish Adeel 
Published: October 2021

Abstract

Aims
After superficial parotidectomy, the incidence of facial nerve injury, for pleomorphic adenoma of the parotid gland, remains the topic of interest despite different techniques to identify the nerve during surgery. We aim to evaluate the incidence of facial nerve injury in patients undergoing superficial parotidectomy in the absence of nerve conductor.

Methods
After calculating sample size, 101 patients irrespective of age and gender were included in this cross-sectional study at the Department of Surgery, for nine years, from 1st January 2012. The primary outcome was the incidence of temporary or permanent facial nerve injury with a follow-up period of 12 months. The data was calculated using SPSS version 23, where mean and standard deviation were calculated for continuous variables, and frequencies were calculated for categorical data.

Results
Facial nerve injury was evident in 16/101 (15.8%) patients. Among these, the main truck of facial nerve was involved in 6(5.9%); temporary loss of function in 4(4.0%) while permanent injury in 2(2.0%). Most common branch of facial nerve affected was marginal mandibular nerve (6, 5.9%), of which 4(4.0%) had a permanent loss. Additionally, four (4.0%) patients developed salivary fistula whereas (2%) patients developed Frey’s syndrome.

Conclusion
Facial nerve injury should be clearly explained, in the consent, to the patient as a medicolegal purpose. Where the nerve stimulator is not available, identification of the proposed anatomical landmarks allows a safe recognition of the facial nerve.
SP7.2.2 Fascial defect closure in laparoscopic incisional/ventral hernia: a systematic review and meta-analysis of published randomized, controlled trials
Authors: Rehman Saad , Akhtar Muhammad Sajjad , Khan Mansoor , Sains Parv , Sajid Muhammad S 
Published: October 2021

Abstract

Aims
Closure of fascial defect (CFD) during laparoscopic incisional/ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR.

Methods
A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis.

Results
A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z = 0.21; P = 0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z = 1.41; P = 0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z = 0.18; P = 0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z = 1.80; P = 0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z = 2.95; P = 0.003).

Conclusion
Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.