bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC90 Hiatus Hernia post oesophagectomy for oesophageal cancer: incidence & outcomes
Authors: Askari Alan , Wheat Jennifer , Kangatharan Chrishthuka , Ismail Mouhamad , Gourgiotis Stavros , Safranek Peter , Sujendran Vijayendran , Hindmarsh Andrew , Bennett John , Hardwick Richard , O'Neill Robert 
Published: December 2021

Abstract

Background
The development of a hiatus hernia following oesophagectomy is a well-documented occurrence. The aim of this study is to examine the incidence of hiatus hernia formation, the symptoms patient present with and differences between open and laparoscopic/minimally invasive surgery.

Methods
A dataset containing data on all patients from an upper GI regional tertiary referral centre were analysed. All subsequent patients who underwent oesophagectomy between Nov 2014 and Nov 2020 were included.

Results
A total of 268 patients underwent oesophagectomy over this time, of whom 81.0% (n = 217/268) were male and the median age was 68 years old (62-73 years). The median BMI at the time of operation was 27.6Kg/m2 (IQR 24.6-30.7Kg/m2). Over a median follow up of 12 months (IQR 5-21), 4.5% (n = 12/268) developed a hiatus hernia. Amongst these 12, the most common organ in the hernia was the transverse colon (66.7%, n = 8/12) and the small bowel (n = 3). The most reported symptoms in those with a hiatus hernia were respiratory symptoms (cough/breathlessness: n = 5), reflux (n = 3), vomiting (n = 3) and chest pain (n = 3). There was no correlation between BMI and the occurrence of a hiatus hernia (p = 0.145) nor were there differences across males and females in terms of hiatus hernia rates (p = 0.845). In patients who had prophylactic repair of the diaphragm (n = 126/268, 47.0%) the rate of hernia repair was no different (4.8%) compared with those who did not have a prophylactic diaphragmatic repair with sutures (4.2%, p = 0.832). There was however a correlation between the volume of intraoperative blood loss and the occurrence of a hiatus hernia, with increasing blood loss correlating with a higher likelihood of hernia occurrence (r = 0.295, p = 0.037).

Conclusions
Hiatus hernia is a relatively common occurrence after oesophageal cancer surgery, with most patients suffering from chest symptoms, pain, and reflux. Intra-operative blood loss may influence the chances of developing a hiatus hernia. Prophylactic measures such as reinforcing the diaphragm or hiatus with sutures, do not appear to affect hernia rates.
P-OGC92 Esophagogastric Lymphomas; Lymphomas outside Lymphoid tissue
Authors: Younus Hafsa , Thomas Joel Joy , Siddiq Faateh , Sharma Vishali , Fiyyaz Sadaf , Mukherjee Dipankar , Mukherjee Samrat 
Published: December 2021

Abstract

Background
Primary gastric lymphomas are rare tumours and account for 5% of all gastric neoplasms. Esophaphageal lymphomas are even rarer, accounting for 1% of all oesophageal tumours. Incidence of these tumours have been increasing over time and there is increasing need to understand this tumour subtype. This is a single centre study of esophagogastric lymphomas over a period of 15 years.

Methods
Between 2005 to 2020; patients who were diagnosed of having esophagogastric lymphomas, were retrospectively studied. Their clinical records were assessed for age, gender, clinical signs and symptoms, histological type, association with H pylori, LDH levels, stage at diagnosis, treatment type, Endoscopy and clinical follow up and survival.

Results
66 patients were diagnosed of having lymphoma, out of which 4 (6%) were oesophageal and 62 (93.93%) were gastric. Median age was 77 years (Range 41-102 years), 39 were male (59%) and 27(41%) were female. Anaemia was the commonest sign (53%), followed by nausea/vomiting (45%), weight loss (44.5%), abdominal pain (40.6%) and dysphagia (24%). 15.6% patients were found to have H pylori and 10% of patients had Barrett’s. Diffuse Large B Cell Lymphomas were commonest tumours (28.33%) followed by MALToma’s (26.6%). 60% patients were T3/4 at the time of diagnosis and 9.7% had other OG malignancies. 53% patients received antibiotics, 61% received chemotherapy, 16% received chemoradiotherapy and 16% received surgical resection. Median survival was 3 years (range 0-14).

Conclusions
Esophagogastric lymphomas are successfully treated with chemotherapy with promising survival. The stage at diagnosis and presence of comorbidities are limiting factors in overall disease prognosis.
P-OGC96 Oesophagectomy with Enhanced Recovery for Adenocarcinoma in the Elderly
Authors: Adam Mina , Hadjittofi Christopher , Kumar Bhaskar 
Published: December 2021

Abstract

Background
The incidence of oesophageal adenocarcinoma is rising rapidly in high-income countries. Combined with an ageing population, it is expected that the need for treatment, including surgery, will increase in the next decade. Oesophagectomy in patients ≥70 years old has been associated with a higher risk of complications. The aim of our study is to compare the outcomes of patients ≥70 vs &lt; 70 years old, who underwent oesophagectomy for adenocarcinoma with an enhanced recovery (ERAS) protocol.

Methods
A single-centre retrospective study was performed. Eligible cases were divided into the &lt;70 and the ≥70 groups for comparison of baseline variables, postoperative outcomes, and overall survival.

Results
From January 2014 through September 2020, oesophagectomy with ERAS was performed for 230 patients with adenocarcinoma. Most (85%) patients were male. The median age was 70 years. The overall 90-day complication rate was 69.6%. The anastomotic leak rate was 16.1%. The 30- and 90-day mortality rates were 0 and 3.0% respectively. Median length of stay (LoS) was 7.0 days (IQR=5.0) and the readmission rate was 18.7%. The overall complication rate was higher in the ≥70 vs the &lt;70 group (75.6% vs 63.1%; p = 0.038). There was no significant difference in major complications, anastomotic leakage, mortality, LoS, or readmission (p &gt; 0.05) between the groups. Estimated mean survival was lower in the ≥70 vs the &lt;70 group (45.6 vs 57.9 months; p = 0.045).

Conclusions
Elderly patients with oesophageal adenocarcinoma can undergo oesophagectomy with ERAS, achieving similar postoperative outcomes to younger patients. In an era of an ageing population with an increasing disease burden, these findings are encouraging.
P-P04 The cost of acute pancreatitis is amylasing!
Authors: Carr Harry , Morris Timothy , Williams Matthew , Jacob Georgina , Courtney Michael , Kanakala Venkatesh 
Published: December 2021

Abstract

Background
Amylase is the key serum biomarker in the diagnosis of acute pancreatitis, however there is no indication for repeat/serial measurement once the diagnosis is established. It is estimated that £27,000pa is spent unnecessarily on repeat amylase investigations without clinical indication1.
Anecdotally, within the department, unnecessary repeats were being routinely performed. Resultantly, we audited in 2019 and 2020 to understand the extent of the issue. Following the first cycle, pre-rotation departmental talks were given to all relevant healthcare staff.

Aim(s)

Methods
Data was collected and analysed retrospectively over 2 audit cycles (C1 & C2) from 79 patient episodes of admissions to the surgical department of a Northern Major Trauma Centre with confirmed diagnoses of acute pancreatitis between 01/05/2019 – 31/07/2019 and 01/08/2020 – 31/12/2020.
Resources used included: patient notes, IMPAX and WebICE.
Data was collected and analysed by one author in C1 but multiple authors in C2.

Results
Mean age = 60 years.
Male:Female ratio was 8:16 and 24:31, respectively.
Initial amylase was diagnostic in &gt; 75% (61/79).
81 unnecessary repeats performed.
Most patients underwent imaging (75% and 67%) however, only approximately one-third (30.8% and 32.4%) of scans were performed to confirm the diagnosis.
• Despite imaging confirming the diagnosis in 88%, &gt;50% of imaged patients had repeat amylase testing.

Conclusions
The results demonstrate that our intervention, a pre-rotation departmental talk, has significantly reduced the over-requesting of amylase and current practice is of a good standard.
Improvements are still required. Resultantly, we are additionally producing an electronic ‘alert’ into our investigations software that, on requesting a repeat amylase, will prompt clinicians to consider its necessity.
Other centres offering acute treatment for similar patients may benefit from performing a similar audit to optimise care while reducing overall clinical costs.
P-P10 The survival benefit of pancreatic enzyme replacement therapy in adult patients undergoing treatment of pancreatic neuroendocrine tumours
Authors: Thompson Oscar , Hall Lewis , Roberts Keith , Shah Tahir , Bradley Elizabeth , Powell-Brett Sarah , Pande Rupaly 
Published: December 2021

Abstract

Background
Patients with pancreatic neuroendocrine tumours (pNETs), treated with somatostatin analogues (SSAs) or pancreaticoduodenectomy, are at risk of exocrine pancreatic insufficiency. This is frequently undiagnosed but can be treated with pancreatic enzyme replacement therapy (PERT). PERT improves survival and nutritional status in other exocrine pancreatic insufficiency-associated conditions such as pancreatic adenocarcinoma. This single-centre retrospective cohort study aimed to establish whether PERT increases survival or weight maintenance in SSA or pancreaticoduodenectomy-treated patients with pNETs.

Methods
Departmental databases identified patients (n = 82) diagnosed with pNETs between 2009 and 2019 and managed with SSAs and/or pancreaticoduodenectomy. Their baseline characteristics, treatments and outcomes were established from clinical records. Cases (n = 47) received PERT 3 months after either pancreaticoduodenectomy or commencement of SSAs, controls (n = 35) did not. Overall survival was analysed using the Kaplan-Meier method, the log-rank test and multivariable Cox regression. Percentage monthly weight changes were compared using the Mann-Witney U test. The cohort was investigated as a whole and stratified by intervention (pancreaticoduodenectomy or SSAs) as more cases having undergone pancreaticoduodenectomy was a potential confounder.

Results
Median survival was not reached in either group. Cases experienced significantly greater 5-year overall survival (81% vs 53%, p = 0.010), however, PERT was not independently associated with survival (Hazard ratio 0.47, 95% CI 0.17-1.30, p = 0.143). Cases showed superior median weight maintenance (+0.04% vs -0.10% per month, p = 0.013), but had lower mean baseline weights (70.0kg vs 81.9kg, p = 0.003). Considering SSA-treated patients (n = 55) only, cases (n = 27) showed greater median weight maintenance (+0.04% vs -0.21% per month, p = 0.025) and a trend towards improved median overall survival (55.5, 95% CI 10.3-100.7 vs 47.7, 95% CI 19.1-76.4 months, p = 0.054).

Conclusions
PERT may improve the maintenance of weight and therefore nutrition in patients with pNETs, treated with SSAs or pancreaticoduodenectomy. PERT may also convey a survival benefit in this same population, however, due to the numerous factors which affect survival, this study appears underpowered to reliably explore this outcome. Further studies are required to accurately define the use and benefits of PERT in this population.
P-P14 A multi-centre retrospective cohort study exploring weight loss and nutritional interventions in severe acute pancreatitis
Authors: Bourne David , Bibby Neil , Button Emily , Kenny Tara , Labaquere Marie , Lander Tom , Latimer Kate , Mahon Mary , Duggan Sinead , Griffin Oonagh 
Published: December 2021

Abstract

Background
Acute pancreatitis is among the most common acute gastrointestinal diseases. Severe acute pancreatitis (SAP) develops in up to 20% of patients and is associated with increased morbidity and mortality. Patients may have long and complex hospital admissions; nutritional support is a cornerstone of management. Due to increased metabolic demands and development of pancreatic exocrine insufficiency (PEI) patients frequently endure excessive weight loss. There has been little research into the effect of SAP on nutritional status and necessary nutritional interventions. This project aimed to characterise weight loss in SAP, routes of feeding, and PEI - including pancreatic enzyme replacement therapy (PERT).

Methods
Participating centres were recruited via the Nutrition Interest group of PSGBI and were required to retrospectively recruit 5-10 consecutive patients admitted following January 1st 2018 using a predefined data collection tool. Inclusion criteria included; age ≥18 years and diagnosed SAP of any aetiology (defined by organ failure of &gt; 48hrs). The exclusion criterion was where death occurred during hospital admission. Data were collected regarding, weight changes, anthropometric measures, nutritional interventions used, PERT administration and diabetic status, including insulin use. All analyses were performed with IBM SPSS 22 (IBM Corp. Armonk, NY), with p &lt; 0.05 considered statistically significant.

Results
34 patients (22 male) from five centres met the inclusion criteria and were included in data analysis. Most common aetiologies were gallstones (13/34) and alcohol (11/34). A mean weight reduction of 12.6% (SD ± 10.77) (p &lt; 0.001) was observed. Multivariate analyses showed that higher premorbid weight (p = 0.02) and PERT administration with tube feeding (p = 0.005) were associated with weight loss. Most patients (29/34) received tube feeding; mean duration 56.8 (SD ± 58.29) days. There was a significant increase in patients with diabetes requiring insulin therapy from admission (n = 3) to discharge (n = 9) (p = 0.03). Most (29/31) patients required oral PERT prescription on discharge.

Conclusions
Patients with SAP lost significant weight during the course of their illness despite aggressive, extended nutritional support and the correction of PEI with PERT. The significant increase in insulin dependence among patients with diabetes, and the number of patients requiring PERT on discharge, reflects the destructive effect SAP has on pancreatic function. These multicentre findings could be used as a baseline for determining effectiveness of nutritional interventions in SAP and may provide a basis for further prospective research in this area.
P-P18 Thoracic epidural VS intrapleural analgesia for pancreaticoduodenectomy – a study on analgesic and non-analgesic outcomes
Authors: Yao Lu , Rajaretnam N , Smith N , Massey L , Rockett Mark , Aroori Somaiah 
Published: December 2021

Abstract

Background
Thoracic epidural analgesia (TEA) has been the traditional option for post-operative pain management for Kausch-Whipple pancreaticoduodenectomy (KWPD) via a ‘reverse L’ incision. An alternative option with inter-pleural analgesia (IPA) has become popular. However, the superior form of analgesia for KWPD regarding analgesic and non-analgesic outcomes is unclear. This study aims to establish if IPA is equivalent to TEA.

Methods
Retrospective study of all patients who underwent KWPD with ‘reverse L’ incision by a single surgeon between February 2014 to June 2016. All received either IPA or TEA post-operatively; patients who had rectus sheath catheter and spinal anaesthesia were excluded. To reduce bias, the Anaesthetist, rather than Surgeon, decided the choice of analgesia based on personal skill. Efficacy regarding analgesia were collected by nursing staff as patient-reported pain severity (mild, moderate or severe). Data were collected from patient case notes and electronic records. This study analysed analgesia efficacy, complications, inotrope use, and intensive treatment unit (ITU) stay.

Results
A total of 40 included in the study. Twenty-two patients had TEA (45% female, median age 68 years) and 18 had IPA (44% female, median age 67 years). Median Charleson Comorbidity Index (CCI) was 5 for both. Patient-reported pain was not statistically different (p = 0.15). We noted more analgesia complications with TEA (not working=4, leakage=2, haemodynamic instability=1, lower limb anaesthesia=1) than IPA (leakage=1; p = 0.027). Eleven (50%) TEA and eight (44%) IPA patients required inotropes. TEA patients required significantly longer duration (median duration 35 VS 18 hours, p = 0.047). Median ITU stay was 3 and 2 days for TEA and IPA patients, respectively.

Conclusions
Both TEA and IPA provide adequate pain relief for KWPD performed via a ‘reversed L’ incision. However, evidence suggests TEA was associated with significantly more analgesia-related complications and longer inotropic requirements. Furthermore, there was also a trend towards ITU stays with TEA. Therefore, we would recommend the use of inter-pleural analgesia over thoracic epidural.
P-P24 Optimising post-operative nutrition in patients undergoing pancreaticoduodenectomy
Authors: Gray Katie , Rana Mridul , Ceresa Carlo , Udupa Venkatesha , Soonawalla Zahir , Silva Michael , Friend Peter , Reddy Srikanth 
Published: December 2021

Abstract

Background
A considerable number of patients undergoing pancreaticoduodenectomy require supplemental nutrition in the postoperative period. However, there remains no national consensus on the optimal postoperative supplemental feeding modality. Furthermore, at our institution a variation in practice exists when considering post-operative entera (via the naso-jejunal (NJ)) or parenteral nutrition (PN). This study aimed to evaluate the utility of post-operative enteral or parenteral nutrition at our centre and to explore risk factors predisposing patients to post-operative nutritional deficits requiring supplementation.

Methods
We retrospectively analysed the electronic case records of all patients undergoing a pancreaticoduodenectomy between November 2019 and November 2020 at our HPB specialist centre. Key patient demographic data and post-operative nutritional requirements with route, length and indication for supplemental feeding as well as biochemical markers, length of stay (LoS) and complications were collected and analysed. Data were analysed via intention to treat analysis.

Results
48 patients underwent a pancreaticoduodenectomy, of which 26 had an NJ tube inserted intra-operatively. 16 (33%) patients required supplemental feeding, via NJ route in 7 and PN in 9. 2 patients were intolerant to NJ feeds and progressed to PN. NJ fed patients had shorter LoS (12(10-42) vs. 28(14-63) days)(p = 0.09) compared to PN feeding. PN-related line infection or thrombosis in 4 (36%) patients. Supplemental feeding met daily kcal requirements in 13 (81%) patients, but PN was associated with greater weight loss (-5%) than NJ feeding (-3%). Significantly increasing the risk of needing supplemental nutrition: advanced age(p = 0.04), ASA≥2(p = 0.04) and anastomotic leak(p = 0.02).

Conclusions
In this group of patients, NJ feeding was largely well-tolerated and the majority of patients met their required daily kcal via this route. Due to the increased incidence of complications associated with PN, NJ feeding should be considered as the 1st line option for post-operative nutritional supplementation, with intra-operative insertion of an NJ tube considered for higher-risk patients.
P-P30 Outcomes from resection of pancreatic metastases and non-neuroendocrine, non-pancreatic tumours
Authors: Stevens Claire , Chin Sirr Ling , Karavios Dimitrios , Takhar Arjun , Arshad Ali , Hamady Zaed , Armstrong Thomas , Pearce Neil , Primrose John 
Published: December 2021

Abstract

Background
Isolated metastatic disease within the pancreas is an uncommon finding. The potentially higher perioperative risk and low incidence of resectable metastases has limited the development of evidence based guidelines for pancreatic metastectomy. However, reports in the literature suggest a considered approach to resecting patients with limited disease, favourable tumour type and a significant disease free interval. The aim of this study was to examine the indications and outcomes of pancreatic resection for metastatic disease and non-pancreatic, non-neuroendocrine malignancy at a high-volume pancreatic surgery centre.

Methods
This is a retrospective analysis of a prospectively managed database of pancreatic resections for metastatic disease or primary non-pancreatic, non-neuroendocrine tumours at a single institution. Data collected and analysed included patient demographics, operative details and peri-operative outcomes, subsequent survival and mode of recurrence.

Results
Records of 711 patients who underwent pancreatic resection were examined. 21 consecutive patients met the inclusion criteria, representing 3% of the unit’s throughput. The perioperative morbidity and mortality were 33% and 0% respectively. Overall survival was 86months (95%CI 63-107) for renal cell carcinoma and 64months for other tumours.

Conclusions
When coupled with the low morbidity and mortality rates of a high-volume pancreatic surgery centre using careful patient selection, pancreatic metastectomy has the potential to result in good long-term survival. Recent improvement in the efficacy of systemic therapies, particularly for renal cell carcinoma and melanoma contribute to the utility of resection and to the improved survival of patients.
P-P33 Quality of Life Assessment in Patients undergoing Robot Assisted Pancreaticoduodenectomy
Authors: Muhammad Qazi Rahim , Farrugia Alexia , Poole Hope , Ali Majid , Marangoni Gabriele , Ahmad Jawad 
Published: December 2021

Abstract

Background
Robot-assisted pancreaticoduodenectomy has recently gained attention as there is evidence from high volume centres suggests better outcomes and quick recovery. This study aimed to evaluate the quality of life after robotic-assisted pancreaticoduodenectomy

Methods
The study included the first 12 consecutive patients who underwent robotic pancreaticoduodenectomy. The RAND SF 36-Item health survey form was used to assess the quality of life through a one-hour face-to-face interview carried out by a junior doctor from a different team with no prior involvement in patient care. The interview was carried out at least three months postoperative period. Each item in the subscale was recorded with a pre-coded numeric value. The comparison was made between preoperative periods' scores defined by the onset of disease symptoms to surgery and the postoperative follow-up score. The SF-36 survey questions were supplemented with additional items such as postoperative pain, emotional wellbeing, and fatigue status.

Results
Analysis of SF-36 domains showed better quality of life postoperatively than the baseline, as evidenced by the mean physical functioning score from 82.91 to 90 and mean general health score from 37.9 to 69.5 postoperatively. 91.66% of the patients reported that they felt better at the time of study and were happy overall.

Conclusions
Robotic-assisted pancreaticoduodenectomy shows a better quality of life than in the preoperative period, which can be attained in a brief postoperative period.