bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-L01 Newly detected liver nodules with a history of colorectal cancer: are they metastasis?
Authors: Zhu Kai , Wang Xiaoying , Zhou Jian 
Published: December 2021

Abstract

Background
The diagnosis of newly detected liver nodules in patients with colorectal cancer (CRC) is crucial for determining prognosis and treatment. Accurate identification of benign nodules can help avoid unnecessary therapy. The aim of our study was to retrospectively review CRC patients who underwent liver resection for newly detected liver nodules in our institution.

Methods
We went over all patients with a history of CRC, who underwent liver resection from January 2012 to December 2019 in our institution. We specifically focused on nodules pathologically confirmed benign. Clinicopathological characteristics of these patients were collected.

Results
From 2012 to 2019, a total of 2632 CRC patients received liver resection for liver nodules, among which 2584 cases were proved to be malignant, and 48 cases were benign. Among these 48 cases, 24 were pathologically confirmed as focal nodular hyperplasia (FNH), 10 were inflammatory lesions, 9 were peliosis, and 5 were hemangioma. At least one pre-operative imaging examination (MRI, US, or PET-CT) indicated CRLM, while no one underwent gadoxetic acid-enhanced MRI. The median size of nodule was 2.0 cm (range, 0.4-8.0 cm). For therapy, ten patients received laparoscopic surgery, and 38 patients received open surgery; ten patients received chemotherapy after discovery of liver nodules.

Conclusions
Newly detected liver nodules with a history of colorectal cancer could be benign. Gadoxetic acid-enhanced MRI should be considered especially for indeterminate liver nodules that would be mimicker of colorectal cancer liver metastasis.
P-L04 Temporal changes in prevalence and associated risk factors for gallbladder dysplasia and adenocarcinoma in patients undergoing cholecystectomy. A UK hospital-based observational study
Authors: Lam Stephen , Chou Wing , Toogood Giles , Wemyss-Holden Simon , Tsigka Alexia , Kumar Bhaskar 
Published: December 2021

Abstract

Background
A metaplasia-dysplasia–carcinoma sequence is the most plausible carcinogenic pathway for gallbladder cancer. Although the incidence of gallbladder carcinoma is increasing, little is known about its precancerous lesions. The aim of this study was to determine temporal changes in the prevalence of low-grade dysplasia (LGD), high-grade dysplasia (HGD) and gallbladder adenocarcinoma and associated risk factors.

Methods
We retrospectively identified consecutive patients who underwent cholecystectomy between January 2011 and March 2020. Patients were grouped according to histology: no dysplasia; LGD; HGD; and adenocarcinoma. Fitted linear models estimated temporal trends in prevalence and mean age for all histological outcomes. Logistic regression estimated associated risk factors.

Results
A total of 5 835 patients were included in the analysis. The prevalence of LGD was 1.47%, HGD 0.17% and adenocarcinoma 0.19%. Prevalence for all diseases increased over time, and mean age at diagnoses decreased over time. In a multivariate logistic regression model, with no dysplasia as the reference group, female sex increased the odds of LGD (OR 4.57, 95% CI 3.07-10.10, p = &lt;0.0001). BMI was not associated with disease risk.

Conclusions
Our data suggests the prevalence of precancerous gallbladder lesions are increasing in younger patients. Although a risk factor for cholelithiasis, BMI was not associated with disease progression. If occurring in a dysplasia-carcinoma sequence, mean age of diagnoses suggests a progression period of 20 years. Further research is required to explain both the significant sex disparity and potential environmental risk factors for gallbladder dysplasia.
P-L05 Enterohepatic migration of ingested fishbone resulting in hepatic abscess- Case report and review of literature
Authors: Grayson Niamh , Shanti Hiba , Patel Ameet G. 
Published: December 2021

Abstract

Background
Ingestion of foreign bodies is common, particularly in children. In adults, most foreign body ingestions are related to food bolus or bone. The majority present with pharyngeal symptoms. Most foreign bodies exit the gastrointestinal tract without complication. However, around 1% result in perforation. Patients may have a delayed presentation with nonspecific symptoms and pose a diagnostic dilemma. We report a rare case of silent migration of a fishbone into the liver and a review of the literature.

Methods
We present the case of a 56 year old man who presented with a liver abscess second to an ingested fishbone. We conducted a PUBMED search and reviewed the published data over a period of thirty years. We identified 52 similar cases and compared the presentation, site of perforation and location of the fish bone. We observed the different approaches in presentation and management of such patients.

Results
A 56-year-old man presented to his local hospital with dull epigastric pain and raised inflammatory markers. CT scan revealed a 4 cm abscess in the left lobe of the liver, with a linear radio-dense body within. The patient was given antibiotics and the abscess was aspirated. The patient was transferred to our Hepatopancreaticobiliary unit for further management. Laparoscopy was performed. The left lateral segment of the liver was adherent to the gastric antrum. The hepato-gastric fistula was disconnected. The fishbone was retrieved from the liver. The abscess was drained and wash out performed. The patient was discharged the following day.

Conclusions
Left lobe liver abscess should raise suspicion of foreign body. Although antibiotic treatment may be effective in the short term, there is no long-term data regarding recurrence. We believe that laparoscopic drainage of the abscess and extraction of the foreign body offer control of the source of sepsis and reduces the risk of recurrence.
P-L07 Nematode infection mimicking Liver metastasis from previous Melanoma
Authors: Bennett Luke , Stevens Claire , Takhar Arjun 
Published: December 2021

Abstract

Background
Malignant melanoma is known to metastasise to the liver. In the absence of any other disease spread it is prudent to resect these lesions. This case highlights how certain pathology can masquerade as liver metastases. Here we present a case of a gentleman previously diagnosed with malignant melanoma in 2016. He had previous liver resection for metastatic disease in 2017. Surveillance MRI picked up what was assumed to be a further metastatic deposit in the right lobe of the liver. Patient underwent resection, and subsequent histological analysis has shown this to be a worm cast from a parasitic infection.

Methods
Review of the current literature reveals just one previous case of nematode infection masquerading as liver metastasis making this a very unusual and rare finding at operation. We have undertaken review of patients imaging and histopathological specimens as well as seeking expert opinion from the infectious diseases centre in London

Results
Images were reviewed in HPB MDT and the suggestion was that this was a new malignant lesion in right lobe of liver. At time of operation the lesion had slightly odd appearance on USS. Specimen was sent for histological analysis and this showed no features to suggest malignant melanoma. On further examination there appeared to be a collection of hyalinised structures suspicious for parasitic infection. The specimen was sent to Guys for further evaluation. This confirmed that this was likely a helminth nematode resulting in a necrotic liver nodule

Conclusions
This presentation is highly unusual and review of the literature demonstrates only 1 previous case to date. The differential for liver lesions is broad and nematode infection should be included. However on a background of previous liver metastases it would not be high on the differential list. It is important that we consider this in future and ensure to clarify risk factors for nematode infection, none of which this patient had. Highlights that despite advancement in imaging it is still only after surgical resection we can be sure of the aetiology.
P-L16 The Impact of Covid-19 on the Management of Primary and Metastatic Liver Cancers; A Single Centre Experience
Authors: Tweedie Adam , McCain Stephen , Mooney James , Jones Claire 
Published: December 2021

Abstract

Background
The Covid-19 pandemic has impacted on all aspects of health care. Surgical specialties have been affected by the impact on theatre time and space, staff re-deployments, reduced ICU capacity for non-Covid patients, and in some cases this has had a significant impact on wait time for surgery and overall surgical capacity. In our tertiary referral HPB unit, the service has been relocated to two different sites throughout the pandemic. We aimed to assess the impact of this on patients undergoing liver resection

Methods
We examined patient data for all patients undergoing liver resection in the 15 month period prior to the introduction of national lockdown, and compared this with all patients who have undergone liver resection since. We looked at total number of cases, ICU admission rates (planned vs unplanned), length of stay, case mix, histology, rates of laparoscopic vs open surgery, and length of time from completing neoadjuvant chemotherapy to surgery. Data were obtained from electronic care records and patient notes.

Results
The overall number of cases was similar (84 pre-covid vs 86 since) and basic patient demographics were unaffected. Median length of stay was the same for both groups (7 days). Colorectal metastases were the underlying pathology in the majority of cases (56/84 pre Covid, 56/86 post). Numbers of laparoscopic and laparoscopic converted to open cases were reduced in the post-Covid era, 12 prior versus four since. The median time from completion of neo-adjuvant chemotherapy to surgery was also affected, increasing from 46 to 62 days.

Conclusions
These data show some differences in patient care in the pre and post-Covid eras, in particular a lower rate of laparoscopic surgery and longer period of time between neo-adjuvant treatment and surgery. Longer follow up is required to see if these trends persist and their effect on long term survival and recurrence rates. However, despite the strains on the system there were similar numbers of patients pre and post Covid, indicating that patients are still presenting and being treated. This showed that staff responded well to the pressures of Covid, and trainee experience would have been similar
P-L17 Post-liver transplant inferior vena cava stenosis in a large volume UK centre
Authors: Spiers Harry VM , Georgiades Fanourios , Walker Ciara , Ashcroft James , Rouhani Foad , Gibbs Paul 
Published: December 2021

Abstract

Background
Inferior vena cava stenosis (IVCS) is a rare complication of liver transplantation with a reported incidence rate of 3%. Limited clinical consensus exists on the management of IVCS. We report the management and outcomes of patients with IVCS at our transplant centre.

Methods
Relevant data were collected from adult patients who underwent liver transplantation at our centre between October 2014 and August 2020. These included demographics, investigation and management details with regards to IVCS. Values presented as % of total and median with interquartile range (IQR).

Results
A total of 636 liver transplants were performed during the study period, of which 48 (7.6%) patients were investigated for possible IVCS. Of those, 14 (2.2% of total) were found to have IVCS, 85.7% (n = 12) were female. Only 2/14 were re-transplants and pre-transplant portal vein thrombus was present in 3 cases (21.4%). 10 livers (71.4%) were DBD donors. Normothermic machine perfusion was used in 4/14 patients. All 14 recipients found to have IVCS had had an implantation using a modified piggyback cavocavostomy technique. The IVCS was identified at a median of 25.5 days (19.7-30.8 days) following transplantation within the suprahepatic IVC in 92.9% (n = 13). Hemi-azygos collateralisation was seen in 4 cases (28.6%). 8 of the 14 recipients underwent intervention for IVCS, 6 patients were managed with balloon venoplasty, 1 patient required an IVC stent and 1 was managed surgically. Six of the recipients with IVCS died, 4 of whom had an intervention for their stenosis and 3 of these were within 90 days of their transplant. Pressures measured at the anastomotic stricture were higher in those who succumbed (median of 21 Vs 12.5 mmHg; p=.017).

Conclusions
At our centre, cava-replacement technique was not associated with IVCS. Patients with more significant strictures (as evidenced by higher pressures at the anastomotic stenosis) may have an increased mortality risk.
P-O02 Management Experiences of Post-gastrectomy Severe Alkaline Reflux Oesophagitis
Authors: Phoenix Eimear , Temperley Hugo , Donlon Noel , Donohoe Claire 
Published: December 2021

Abstract

Background
Alkaline reflux oeosphagitis is a recognized complication of procedures that compromise the lower oesophageal sphincter (LES), including gastrectomy. Incidence of reflux is dependent on the reconstructive procedure with Roux-en-Y esophagojejunostomy commonly accepted as the optimal method. The authors report their experience of 6 patients who underwent remedial intervention for severe alkaline reflux esophagitis following gastric surgery.

Methods
A retrospective review of 6 patients who had underwent a previous gastric procedure and developed symptoms of gastroesophageal reflux disease, over a 6-year period (2014-2020). Reflux symptoms were diagnosed by clinical history, radiology, endoscopy and esophageal manometry prior to proceeding to surgical reflux control. Post-operative outcomes following anti-reflux surgery were assessed by means of serial outpatient assessments and endoscopy.

Results
Six patients were included in this report, 4 males and 2 females with an average age of 73 years (range 58-91). Primary diagnoses encompassed; 4 gastric adenocarcinomas, 1 gastric neuroendocrine tumour and 1 patient with debilitating gastric antral vascular ectasia (GAVE) syndrome. Four patients underwent total gastrectomy and 2 subtotal gastrectomy with Roux-en-Y reconstruction. Onset of post-operative reflux symptoms ranged from 2-weeks to 3-years. Failing medical management, all patients underwent jejunojejunal anastomosis and Roux limb length revision with surgical jejunostomy. At follow up 5 patients had some degree of symptom resolution; 3 complete resolution, 2 initial resolution and 1 with unresolved symptoms.

Conclusions
Severe alkaline reflux oesophagitis is a recognized complication of gastric procedures compromising the LES. The authors report our experience of managing this complication following gastrectomy with jejunojejunal anastomosis and Roux limb length revision, with a majority of patients having improvement in if not complete resolution of reflux symptoms.
P-O14 The predictive role of pre-operative liver function tests in outcomes following emergency appendicectomy
Authors: Khan Khurram , Galbraith Norman , Gall Lewis , Macdonald Andrew 
Published: December 2021

Abstract

Background
Acute appendicitis remains one of the most common diagnoses in emergency general surgery, with recent evidence from the COMMA trial confirming that appendicectomy is the cornerstone of definitive management in most patients. With a wide range of severity and of patient physiology, complications are a burden to patients and the health service. We hypothesised that liver function tests have predictive value for complications following emergency appendicectomy.

Methods
A multicentre retrospective observational study was carried out across 4 hospitals (2 teaching centres and 2 district general hospitals) for adult patients who underwent emergency appendectomy between August 2018 and November 2020. Patients were identified through pathology records and data was extracted from electronic case records for patient demographics, pre-operative routine laboratory results, operative details, and clinical outcomes. Peak perioperative liver function parameters were analysed using unpaired two-way T-tests, Pearson’s correlation coefficient, ANOVA and multivariate regression to determine their relationship with conversion to open surgery, superficial and deep surgical site infection (SSI), length of stay (LOS) and 30-day re-admission rates.

Results
Of 1131 patients included, 57.4% were male, 80.5% were laparoscopic, with 7.3% converted to open, 10.8% performed open, and 1.5% by laparotomy. Mean LOS was 3.81 (SD4.0) days, 6.3% readmission rate, with 2.3% superficial SSI and 5.0% deep SSI.
ALP was higher in patients with superficial SSI (p &lt; 0.001). Lower ALT was associated with wound dehiscence (p &lt; 0.001). Bilirubin, AST and ALT were lower in patients with chest infections (p &lt; 0.001). ALP correlated with increased LOS (p &lt; 0.001).
On multivariable regression, ALP was associated with superficial SSI (p &lt; 0.001), and LOS (p &lt; 0.001). ROC curve analysis demonstrated AUC of 0.655 for ALP and superficial SSI.

Conclusions
Emergency appendicectomy is completed laparoscopically in more than 80% of patients and complication rates are acceptable. Routine liver function tests were associated with important clinical outcomes including superficial SSI, wound dehiscence, chest infection, LOS and readmission rate. Patients who had superficial SSI, wound dehiscence, chest infection and readmission with 30 days had lower transaminase levels compared with those with uncomplicated recovery.
P-O17 The Royal Stoke Green Pathway: a method to undertake safe UGI surgery during the COVID pandemic
Authors: Ghassemi Nader , Meilak Joseph , McKay Siobhan C , Bhatt Anand , Durkin Damien , Athwal Tejinderjit 
Published: December 2021

Abstract

Background
During the first wave of the COVID pandemic surgical services we paralysed globally, with cancellation of an estimated 28-million operations during the first 12 weeks. Worryingly, surgical patient with COVID were reported to have unacceptably high peri-operative mortality, approaching 25%. However, there was an urgent clinical need to progress with category 1 and 2 operations, to prevent disease progression and avoidable morbidity and mortality from non-COVID pathologies. During the second and subsequent waves of the pandemic it was vital to protect patients from peri-operative COVID whilst undertaking urgent surgery safely.

Methods
Our centre developed a ring-fenced 'Green Pathway' for category 1 and 2 patients requiring surgery. Patients were treated in physically separate area of the hospital, with no interaction between COVID and non-COVID patients, healthcare staff or facilities. Patients self-isolated for 14-days prior to admission, and had pre- and peri-operative COVID RT-PCR tests. We assessed outcomes for patients immediately prior to the introduction of the Green Pathway (1/10/2020) and following implementation (31/12/2020) to assess safety. Textbook outcomes for pancreatoduodenectomy were compared to assess safety and quality. Other data suggests that UGI surgery couldn't continue in other hospitals from December 2020.

Results
There were 47 admissions to surgical HDU following category 1 and 2 upper GI operations during the study; 31 pre-pathway (PP) implementation, and 16 green pathway (GP) patients.
Median age 66-years (43-78 range) PP vs 65-years (range 42-74) GP, median ASA 3 vs 2. Median HDU length of stay (LOS) 5-days vs 7-days, and median hospital LOS 11.5-days vs 9-days for PP vs GP respectively. There were 6 cases of peri-operative COVID in PP cohort, and 1 in GP (contract following discharge). There was no mortality within either cohort. For the subgroup of patients undergoing PD: 10 patients PP, 6 patients GP, textbook outcomes were achieved in 90% vs 67% PP vs GP.

Conclusions
The implementation of the Green Pathway at our institution enabled continuation of surgery for patients with category 1 and 2 operations during the COVID pandemic with a significant reduction in peri-operative COVID infection, no mortality and no increase in length of stay. The TO rate was lower with the GP (not statistically significant), but our 4-year institution TO rate is 70.3%, comparing favourably to other studies. This pathway has enabled safe continuation of urgent surgery during the pandemic and could be a model for adoption in other centres especially if there is resurgence of COVID cases during the coming winter.
P-OGC02 The development of an evidence based algorithm for the provision of nutrition as part of an Enhanced Recover After Surgery (ERAS) pathway in patients undergoing elective Gastrectomy and Oesophagogastrectomy for cancer
Authors: Dossou Vida , Cleary Ally 
Published: December 2021

Abstract

Background
Following a recent merger or UGI Cancer services, a consensus was needed for the ERAS pathway nutritional elements. ERAS is a way to maintain physiological function following surgery enabling post-operative recovery without adversely affecting morbidity or mortality.
It is a coordinated pathway that enables consistent, evidence based multi-modal care. Anaesthesia, nutrition, analgesia, surgical technique and physiotherapy are active and key components of enhanced recovery along with patient involvement and empowerment.
ERAS in UGI revealed a significant reduction in LOS in most cases, by around 50% without increasing morbidity and mortality when compared to standard post-operative care.

Methods
Coupling the service redesign with the publication of guidelines in ERAS and Gastrectomy, it was decided to review the evidence base for ERAS and nutrition support specific to UGI Cancer surgery.
In addition to this, aim to review the evidence for and against the use of immunonutrition (IN).
Literature searches were conducted using CINAHL and PUBMED databases. The evidence was critiqued and a consensus reached. From this evidence review, an algorithm recommending the instigation of nutrition post Upper Gastrointestinal (UGI) surgery as part of an ERAS pathway was developed.

Results
An algorithm was produced standardising the nutritional care for patients undergoing elective UGI surgery in our centre, which formed part of the ERAS care pathway produced through the ERAS steering group. All patients were screened for risk of malnutrition at the start of their surgical care pathway and regularly throughout their journey, appropriate nutritional support will be provided by a specialist Dietitian to optimise the patient.

Conclusions
The evidence to support the use of IN is conflicting and is not currently recommended on this ERAS pathway.
Nutritional intake in the form of Oral Nutritional Support (ONS) in subtotal gastrectomy can be commenced at Day 2.
Nutritional intake in the form of ONS in Total Gastrectomy can be commenced at Day 4.
Nutritional intake in the form of ONS in Oesophagogastrectomy can be commenced at Day 5.
After ONS tolerated without clinical symptoms, patient can be progressed to Soups, Jellies, Ice creams for 24 hours then to an UGI specific soft menu pre discharge.