bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC65 Patterns and timing of recurrence following resection of oesophago-gastric adenocarcinoma
Authors: Shen William , Craig Carol , MacDonald Andrew , MacKay Colin , Forshaw Matthew , Dreyer Stephan 
Published: December 2021

Abstract

Background
Recurrence following resection of oesophago-gastric adenocarcinoma (OGA) is frequent and associated with poor outcomes. Predictors of site, timing and mechanisms driving recurrence is poorly defined, which limits the development of anti-metastatic agents. The aim of this study was to investigate the patterns and timing of recurrence following resection of OGA.

Methods
Retrospective review of a prospectively maintained resection database from the Glasgow Royal Infirmary oesophago-gastric unit of patients undergoing surgery for OGA. Primary outcomes were recurrence and cancer specific death following surgery. Recurrence patterns were defined as liver, lung, peritoneal, locoregional only and other distant groups. The latter is a heterogenous group that do not include any liver, lung, or peritoneal metastases.

Results
N = 635 patients were identified having undergone surgical resection of OGA. Of these, n = 262 developed confirmed recurrent disease. Liver metastases (n = 86, 33%) were the most common site of recurrence, followed by peritoneal (n = 35, 13%), lung (n = 33, 13%) locoregional only (n = 51, 20%) and other distant sites (n = 57, 22%). Liver recurrence was associated with significantly worse disease specific (19.1 vs 28.2 months, P &lt; 0.001) and recurrence free survival (P = 0.006). There was no association between site of recurrence and known prognostic clinicopathological factors, including anaerobic threshold (P = 0.810), nodal status (P = 0.088), pathological T-stage (P = 0.357), differentiation (P = 0.195), deprivation index (P = 0.996), perineural (P = 0.475) or lymphovascular (P = 0.422) invasion.

Conclusions
Liver metastases is the most common site of recurrence following surgery for OGA. Prognostic clinical and pathological factors do not determine the site of recurrence, suggesting that molecular features of the primary tumour determine and promotes recurrence patterns. Further study to delineate the molecular and microenvironment factors driving recurrence patterns is urgently required.
P-OGC72 Morbidity following oesophagectomy: the long-term re-operation rate after surgical resection in a Scottish tertiary centre
Authors: Chien Siobhan , Gall Lewis , Khan Khurram , Macdonald Andrew , Craig Carol , MacKay Colin , Forshaw Matthew 
Published: December 2021

Abstract

Background
Oesophagectomy remains the best curative option for early stage or locally advanced cancers of the oesophagus and gastro-oesophageal junction. The long-term morbidity associated with oesophagectomy is poorly understood. This study aimed to describe re-operation rates for oesophagectomy-related complications, performed beyond 90 days from index oesophagectomy.

Methods
A retrospective cohort study of all oesophagectomies performed in a single tertiary centre between 01 January 2010 and 31 December 2019 was performed. Electronic records were interrogated and patients dichotomised into two groups, with patients that underwent re-operation at ≥ 90 days after oesophagectomy for complications directly related to the index procedure compared to patients who did not have further surgery. All endoscopic interventions were excluded from analysis. The median length of follow-up was 34 months (IQR 20-67).

Results
343 patients were eligible for analysis. Patient demographics and index operative approach were similar between the two groups. Beyond 90 days from surgery, 8.7% of patients (30/343) required a further operation for complications directly related to oesophagectomy. The median time to re-operation was 15.5 months (IQR 12-29). 28 out of a total of 38 re-operations performed (73.7%) were for wound complications (including 15 incisional hernia repairs and 7 excision of stitch sinus). Development of a wound infection in the immediate post-operative period was associated with an increased rate of later re-operation (16.7% vs. 4.8%, p = 0.022).

Conclusions
A small but significant number of patients require re-operation following oesophagectomy beyond 90 days of surgery. This should form part of the pre-operative informed consent discussion in order to fully appraise patients and manage expectations. Reducing the incidence of early wound infection appears to be a key factor.
P-OGC76 A patient engagement event to assess feasibility of preoperative enhanced recovery groups in patients with oesophagogastric cancer undergoing surgery
Authors: Jarvis Emma , Evans Orla , Mundle Georgia , Noor Zainab 
Published: December 2021

Abstract

Background
Enhanced recovery (ER) includes pre-operative counselling during individual patient consultations with multidisciplinary team (MDT) members. Patients can experience lengthy appointments seeing multiple professionals. This negatively impacts on their ability to retain and process information, and results in long, overrunning clinics. Separate, virtual ER group sessions have been proposed to deliver aspects of the pre-operative appointment which are common to all patients undergoing oesophagogastric (OG) cancer surgery. The aim is to improve patient engagement and experience, and improve efficiency of clinics. A patient engagement event was undertaken to gain feedback from patients about the existing service and the proposed virtual group.

Methods
A semi-structured telephone interview was developed with the support of a Patient & Public Engagement Team. The 30 minute interview covered aspects such as patient experience of ER information delivery, the quality of the information they received and their thoughts on attending virtual group sessions. Seventy patients, who had undergone surgery for OG cancer in the previous 14 months were invited to take part. A Health Informatics Team screened the patient list prior to invitation letters being sent. The telephone interviews took place in November 2020.

Results
Twenty-seven patients responded (37%). Of these, 89% felt they received all information required for surgery preparation. Over 50% reported receiving adequate information to support with common post-operative issues (dietary - 81%; physical activity - 55%) but would like more on others (psychological impact - 26%). Patients highlighted that the MDT clinic took many hours and information delivery was overwhelming.
The internet was accessible to 85% and 56% thought the information provided prior to surgery could have been delivered in a virtual group. Patient perceived advantages to virtual groups included: peer support; reduced travel; and avoidance of information repetition and overload.

Conclusions
Patient preference, perspective and needs are paramount when designing healthcare services. Results from this patient engagement event suggest that the delivery of preoperative information and counselling as part of ER could be improved through the implementation of virtual ER groups. They also suggest that most patients perceive benefits to such a model, including the addition of peer support. The next steps in the proof of concept are to develop the virtual groups MDT content and pilot in a cohort of patients, evaluating patient related outcome measures and impact on service efficiency.
P-OGC78 One year experience of a newly established super green ERAS pathway for performing oesophago-gastric cancer resections during the Covid-19 pandemic
Authors: Sahni Dhruv , Khan Khurram , Gall Lewis , Kosk Paulina , Forshaw Matthew , Macdonald Andrew , Craig Carol , MacKay Colin 
Published: December 2021

Abstract

Background
Surgical oncology services in the UK have been impacted by the COVID-19 pandemic. Various strategies have been employed in an attempt to continue cancer resectional surgery during the pandemic. This study examined our institution’s experience and outcomes with a newly established Super Green ERAS pathway for oesophago-gastric (OG) cancer resections during the pandemic.

Methods
A retrospective cohort study of consecutive patients who had a resection for OG cancer performed over a 12-month period beginning from the date of the first UK National Lockdown of 23 March 2020. Barring two intervals each lasting 3 weeks, urgent elective cancer surgery continued on our mixed hot and cold site through the establishment of a Super Green ERAS pathway.
Patients were confirmed COVID-19 negative within 72 hours pre-admission and retested 72-hourly post-op. 14 days self-isolation pre-admission was mandated. Patients not complying had their surgery postponed. Transhiatal oesophagectomy was the preferred approach for oesophagectomy during the pandemic.

Results
45 resections (33 oesophagectomies, 10 gastrectomies and 2 trial of dissections) were performed. 37 (82.2%) patients were male with a median age of 64 (IQR 58-71) years. 3 patients were postponed due to non-adherence with self-isolation.
No patients tested positive for COVID-19 post-operatively, hence, there was no COVID-19-related morbidity. Nine patients developed pneumonia. Seven patients had an anastomotic leak, all of whom were successfully rescued. One patient required a clamshell thoracotomy due to intra-operative mediastinal bleeding followed by a return to theatre for reconstruction 48hrs later. Median length of stay was 12 (IQR 9-18) days. There was no in-hospital mortality.

Conclusions
OG cancer resections can be performed safely despite COVID-19, with favorable clinical outcomes when a Super Green ERAS pathway is strictly adhered to. Implementation of such pathways will enable surgical oncology services, including OG cancer resections, to continue to ensure best possible outcomes for cancer patients despite any future waves of the COVID-19 pandemic.
P-OGC89 Peri-operative blood use in Upper GI surgery
Authors: Mercer Alexandra , Houston Martin , Harris Andrew , Millen Steven 
Published: December 2021

Abstract

Background
One group and hold sample costs approximately £18 to process whilst it costs £170 to prepare and administer 1 unit of cross matched blood. We aimed to quantify the amount of blood cross-matched for elective oesophagectomy and gastrectomy cases and compare this to the number of units transfused in the peri-operative setting (within 24 hours of surgery). Current unit guidance required all patients to be cross matched for 2 units of blood pre-operatively.

Methods
Baseline data was collected retrospectively over a 10 week period (08/07/19-16/09/19). A new blood ordering protocol, made in agreement with oesophago-gastric and anaesthetic consultants was produced. Blood was only to be requested if: antibodies on group and hold, pre-op Hb &lt; 120g/l, operative team concerns or previous radiotherapy. Data was recollected using the same parameters post -intervention over a 10 week period (23/12/19-08/03/20).

Results
Before implementation of the protocol 24 patients were included, mean age 67 (range 40-84). All patients were cross matched between 2 and 4 units, with a total of 52 units requested and only 1 transfused. After implementation of the protocol 27 patients were included, mean age 69 (range 51-87). 36 units were ordered for 15 patients and 3 units were transfused. The new protocol was correctly implemented in 19 patients (70%). If implemented correctly in all patients in this group a saving of approximately £6120 could have been made. This could equate to a saving of as much as £20,400 per year based on 90 OG operative cases.

Conclusions
Patients were cross-matched far in excess of their transfusion needs. There was significant reduction in the number of patients being cross-matched post intervention. Rationalising this is important to reduce waste, reduce cost and cut down on delays to maximise theatre time.
P-OGC93 Weight Loss and Complications in Oesophagectomy and Gastrectomy Patients
Authors: Ramdin Ashling , Dawas Khaled 
Published: December 2021

Abstract

Background
Oesophagectomy and gastrectomy are major surgeries which often involve patients fasting for prolonged periods of time post operatively thus requiring alternative nutrition regimens. In addition, patients often suffer dysphagia, anorexia, chemotherapy side effects and significant weight loss prior to surgery. Post-operative concerns include delayed gastric emptying, refeeding syndrome and dumping syndrome. Whilst placement of enteral feeding tubes aids the transition back to normal diet there are often still social, physical and dietary challenges that hinder nutrition. The aim of this study was to review weight loss in patients post operatively and to optimise post-operative nutrition.

Methods
The records of 113 patients who had undergone an oesophagectomy (43) or gastrectomy (64) between June 2018 and November 2019 at a single regional cancer centre were retrospectively examined. These patients’ contemporaneous weights had been recorded at set peri operative timelines and the greatest percentage weight loss calculated. The percentage weight loss was matched to the highest Clavien-Dindo post-operative complication.

Results
89 patients had weights routinely reviewed post operatively, with the remainder not having regular post operative weights documented. The median weight loss was 7.53.
For patients undergoing a total gastrectomy (27) weight loss ranged from 7.36-29.2%. Median weight loss was 11.45%. Patients who underwent subtotal gastrectomy (26) had between 0.37-18.5% with a median of 7.83% weight loss. Those who underwent an oesophagectomy (36) had between 0 - 28.67% weight loss with the median being 7.21%. 6 patients had their operations abandoned.
Post-operative complications, inclusive of Grade II and above, occurred in 16.8% of cases. Majority of complications occurred in those undergoing an oesophagectomy (64%), however complications did not correlate with percentage weight loss. The most common complication was grade IIIb (Grade I: 8, Grade II: 1, Grade IIIa: 1, Grade IIIb: 14, Grade IVa: 2, Grade V: 2).

Conclusions
Significant post-operative weight loss is common after oesophagectomy or gastrectomy surgery. Postoperative weight loss did not correlate with complications. Furthermore, there did not appear to be a correlation with weight loss and type of procedure. Nutritional status plays an important prognostic role in patients undergoing oesophagectomy or gastrectomy. Optimising nutrition perioperatively and post operatively is important to enhance post-operative recovery and reduce post operative risk. Reviewing a larger cohort of patients would improve the robustness of this study.
P-OGC95 Understanding the molecular age of Barrett’s oesophagus in a population-representative sample of patients
Authors: Oliveira Talita , Lewis McKenna , Smyth Laura , Turkington Richard , McKnight Amy Jayne , Cairnduff Victoria , McManus Damian , Johnston Brian , Coleman Helen , Curtius Kit 
Published: December 2021

Abstract

Background
The incidence of oesophageal adenocarcinoma (OAC) increases dramatically with patient age but only a small proportion of patients with diagnosed Barrett’s oesophagus (BO), the precursor to OAC, will develop dysplasia and/or cancer. Beyond chronological age, biomarkers of progression that capture biological aging offer largely untapped potential for objectively identifying BO patients at highest risk of progression, who could undergo personalised surveillance at shorter intervals. We have developed computational tools to determine tissue-specific aging using genome-wide methylation data as a “molecular clock” for estimating patient-specific BO dwell times at the time of incident diagnosis that cannot be clinically measured by other means.

Methods
Using the population-based Northern Ireland BO register in a retrospective study, we have identified 46 non-dysplastic BO patients who have 2-4 serial endoscopic biopsies each, and have not progressed to OAC (age range 29-77 years). FFPE biopsies for 10 age-matched patients who had prevalent HGD/OAC at index BO diagnosis were also retrieved. DNA has been extracted, quantified using fluorescence, quality checked through qPCR, and prepared for Illumina EPIC methylation arrays. We created a Python package called “MethylDrift” to determine genome-wide aging rates in patient data. Model outputs are used in the molecular clock for BO tissue age.

Results
We used MethylDrift to quantify aging rates in both cross-sectional data (population-level epigenetic drift) and longitudinal data within the same patients to obtain individual aging rates. Computational analyses using our previously developed Bayesian framework for the BO molecular clock will be applied to estimate the molecular age of BO in patients, i.e., how long the patient has been living with BO since onset of metaplasia. Results will be compared between age groups, birth cohorts, sex, and importantly between dysplastic and non-dysplastic BO to evaluate biomarker potential. Data analysis is ongoing, and the final results will be presented at the meeting.

Conclusions
Our results from this nested case-control study demonstrate feasibility and generate pilot data on molecular age as a proxy of BO duration at the time of incident diagnosis, in a large population-based registry of patients with BO. This will inform our computational tools for determining biological aging and can be applied in future work to investigate progression risk according to molecular age. Ultimately, this biomarker could inform surveillance frequency for BO patients, enable earlier detection of neoplastic progression, leading to improved patient outcomes and optimal distribution of limited endoscopy capacity for surveillance.
P-P05 Acute Pancreatitis during COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in Western Health and Social Care Trust
Authors: Yawar Bakhat , Marzouk Ahmed , Ali Heba , Bahli Zahid , Abousamra Mohammad , Asim Ayeisha 
Published: December 2021

Abstract

Background
Acute pancreatitis is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. COVID-19 pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, primary aim was to ascertain incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30 day mortality, outcomes and management of acute pancreatitis patients from Altnagelvin Area Hospital from 1st March, 2020 till 30th August, 2020.

Methods
A retrospective observational review of all patients admitted under General Surgical team from March 2020 till September 2020 was performed. Information regarding demographics, severity of acute pancreatitis (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on RedCap tool used by COVID-PAN study. The results were compared to outcomes results of COVID-PAN study for COVID-19 negative patients in that study as we had only one patient who was positive for COVID-19 at time of concomitant pancreatitis diagnosis.

Results
Forty four (44) patients were admitted with acute pancreatitis. Only one patient (2.3%) was diagnosed with COVID-19 at time of pancreatitis. Aetiology of pancreatitis was found comparable to aetiology reported by large scale studies (2). Mortality was 7% (3 patients). Five patients (11%) needed ICU admission due to organ dysfunction. Three patients (7%) developed ARDS.

Conclusions
The overall incidence of COVID-19 in pancreatitis in our population of study was low. Therefore, results were compared to patients who were COVID-19 negative in COVID-PAN study. Patients with acute pancreatitis in our target population were mostly elderly, about one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As has been observed in other centres globally, urgent for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy.
P-P11 A tumour responsive, oxygen-generating nanoparticle to combat hypoxia in pancreatic tumours
Authors: Farrell Sian , Nicholas Dean , Nesbitt Heather , Logan Keiran , McMullin Eva , Gillan Tierna , Kelly Paul , O'Rourke Declan , Porter Simon , Thomas Keith , O'Hagan Barry M.G. , Nomikou Nikolitsa , Callan Bridgeen , Callan John F. , McHale Anthony P. 
Published: December 2021

Abstract

Background
Pancreatic cancer remains a significant therapeutic challenge and its poor prognosis has remained relatively unchanged for the past 40 years. Pancreatic tumours are highly desmoplastic and impenetrable lesions in which both gas and mass transfer is severely compromised. This leads to the development of hypoxia within the tumour and this compromises therapeutic approaches that rely on cytotoxic reactive oxygen species, e.g. photodynamic therapy, sonodynamic therapy and radiotherapy. Hypoxia also results in a relatively low pH within the tumour microenvironment. Here we describe a pH sensitive nanoparticle that can generate oxygen in the tumour and enhance ROS generating therapeutic approaches.

Methods
CaO2 NPs were generated by exposing to low frequency ultrasound and subsequently coated using a polymethacrylate polymer that becomes soluble at pH 6.4. For some studies, the sonosensitiser, Rose Bengal was attached to the particles. Oxygen generation in tumours (BxPC3) was demonstrated by inserting a dissolved oxygen probe into tumours following IV administration of particles. Particles were also employed together with photodynamic therapy (PDT) and sonodynamic therapy (SDT) using human xenograft and syngeneic pancreatic tumour models. In some cases, tumour tissues were recovered and analysed for tumour infiltrating immune cells using flow cytometry.

Results

Conclusions
Coating CaO2 nanoparticles with a pH sensitive polymer provides in situ oxygen generation in tumours. Transient provision of oxygen enhances therapies that depend on the generation of cytotoxic reactive oxygen species. When used with SDT, and using a bilateral syngeneic pancreatic tumour model, a powerful abscopal effect was observed and this was shown to be immune-mediated. The above data suggest that the particles may be exploited to enhance other therapies that depend on the generation of ROS, e.g. radiotherapy, and further suggest that the approach can be used to treat either local or disseminated forms of pancreatic cancer.