bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC37 Lymphatic embolisation for chylous abdomen following oesophagectomy
Authors: Ghauri Sherafghan , Abdelrahman Mohamed , Miles Richard , Chan David 
Published: December 2021

Abstract

Background
A 78 year old man underwent an Ivor Lewis oesophagectomy (laparoscopic converted to open abdominal phase, right thoracotomy) for a T2 N2 (3/81) R0 Type II GOJ adenocarcinoma post FLOT neoadjuvant chemotherapy. He developed a chylous abdomen requiring drainage radiologically. A percutaneous lymphatic embolisation was performed which showed a leak in the region of the cisterna chyli which was successfully treated.

Methods
A lymph node in each groin was cannulated under US guidance using spinal needles and an infusion of Lipiodol was started at a rate of 6ml/hr each side. Lymphatic opacification was monitored under fluoroscopy with contrast having reached the cisterna chyli within 30 minutes. Contrast was seen extravasating near cisterna chyli, confirming an injury at this site. A lumbar trunk lymphatic was cannulated with a Chiba needle and wire enabling positioning of a microcatheter as close to the point of injury as possible. Onyx liquid embolic was used to embolise the feeding lymphatic trunk.

Results
Post-procedural drain outputs demonstrated an immediate significant drop, with losses of only 300ml/24hr within 48 hours. Drain outputs continued to taper and the drains removed shortly after. The cisterna chyli is typically thought of as a retroperitoneal/para-aortic structure not prone to instrumentation during an ILGO. Despite reviewing the intra-operative footage, a definitive moment/point of injury remains unclear.

Conclusions
Conservative management of abdominal chyle leak including use of TPN and octreotide is often effective but in sustained large volume ascites(&gt;1000mls/24hr) this is unlikely to succeed. Percutaneous lymphatic embolization can be offered as a treatment option for these patients.
P-OGC40 Enhanced recovery after oesophagectomy at Oxford University Hospitals: the benefit of having a discharge target
Authors: Menon Nainaka , Antonowicz Stefan , Matarangelo Antonio , Ash Stephen , Owen Richard , Ferraro Daniele , Ghafoor Hamira , Gillies Richard , Marshall Robert , Sgromo Bruno , Maynard Nick 
Published: December 2021

Abstract

Background
Enhanced recovery after surgery (ERAS) is a multimodal approach to decreasing morbidity and accelerating return-of-function after major surgery. However, the majority of patients undergoing oesophagectomy for cancer experience some kind of complication, which extends their admission and causes pathway deviation. Thus, the value of having a discharge target (Day 8 at our institution) could be challenged. In this study we reviewed our experience using this pathway, with a focus on: (i) whether length of stay and morbidity has improved since pathway implementation (ii) describing the medical and non-medical reasons for extended admission (iii) identifying pre-operative predictors of pathway deviation.

Methods
A retrospective review of a prospectively maintained database was performed. Complications are recorded during routine clinical care using standardised definitions set out by the Esophageal Complications Consensus group, and are updated in the database at a weekly departmental meeting. Median and interquartile range were used for descriptors and differences tested with Mann-Whitney U test or Chi squared tests, using SPSS ver 26. Multivariable models were fitted to establish independent predictors of pathway deviation, using a binary logistic regression approach with bootstrapping.

Results
150 of 448 patients met the 8-day target. Patients treated since 2018 were significantly more likely meet their discharge date (OR 1.28, P = 0.041) compared to 2015-2017, and have less complications. Surgical quality was unchanged. Thirty-day mortality increased but was still low (0.9% vs 1.8%, P = 0.067). Aside from having a complication (OR 4.15, P &lt; 0.001), independent predictor of delayed discharge was female sex (OR 2.6, P = 0.003), squamous cell cancer histology (OR 2.8, P = 0.014) and low socio-economic status (OR 1.33, P = 0.014), but not age, smoking, BMI, co-morbidities and other baseline variables.

Conclusions
Enhanced recovery after oesophagectomy provides clear goals for the patient and multi-disciplinary team, however the target is often not met owing to the frequent nature of post-operative complications. Nonetheless these targets provide a culture for accelerated recovery, with steady improvement in short-term outcomes over time. A number of specific patient-groups are more likely to have extended admissions independent of complications, which has implications for optimising prehabilitation services. Overall , these findings suggest that having a discharge target is valuable, even though it often is not met.
P-OGC57 Predicting survival and response to therapy using diagnostic biopsies: A machine learning approach to facilitate treatment decisions for oesophageal adenocarcinoma
Authors: Rahman Saqib , Early Joseph , Sharpe Ben , Lloyd Megan , Vries Matt De , Grace Ben , Ramchurn Sarvapali , Underwood Timothy 
Published: December 2021

Abstract

Background
Standard of care for locally advanced oesophageal adenocarcinoma is neoadjuvant chemotherapy or chemoradiotherapy followed by surgery. Only a minority of patients (&lt;25%) derive significant survival benefit from neoadjuvant treatment and there are no reliable means of establishing prior to treatment in whom this benefit will occur. Moreover, accurate prediction of survival prior to treatment is also not possible. The availability of machine learning techniques provides the potential to use complex data sources to answer these problems. In this study, we assessed the utility of high-resolution digital microscopy of pre-treatment biopsies in predicting both response to neoadjuvant therapy and overall survival.

Methods
A total of 157 cases were included in the study. Pre-treatment clinical information, including neoadjuvant treatment, was obtained, along with diagnostic biopsies. Diagnostic biopsies were converted into high-resolution whole slide-images and features extracted using the pre-trained convolutional neural network Xception. Single representative images were converted into patches from which predictive models were trained. Elastic net regression classifiers were derived and validated with bootstrapping and 1000 resampled datasets. The response to treatment was considered according to Mandard tumour regression grade (TRG). Model performance was quantified using the C-index (for TRG) and time-dependent AUC (tAUC, fo Overall survival) along with calibration plots.

Results
Median survival was 78.9months (95%CI 35.9 months – not reached). Survival at 5-years was 52.1%. Neoadjuvant treatment was received by 123 patients (78.3%), with a significant response seen in 45 cases (36.6%). A response was more likely in those patients who received chemoradiotherapy than chemotherapy (53.3% vs 23.1% p &lt; 0.001) and in older patients (median age 69.4 vs 66.0 years, p = 0.038), with other characteristics similar. A predictive model for response to neoadjuvant treatment derived from image features and clinical data achieved good discrimination (C-index 0.767, 95%CI 0.701-0.833) and calibration. Accuracy of prediction of overall survival was more modest (tAUC 0.640, 95%CI 0.518-0.762).

Conclusions
Using a small dataset, utility of a feature extraction pipeline in prediction of patient level outcomes has been demonstrated. This was more marked in prediction of response to neoadjuvant treatment than overall survival, which may reflect the importance of pre-treatment clinical data in determining the former outcome. Further study to refine the methodology and confirmation in larger datasets are required before expansion to clinical settings.
P-OGC66 Mental Health and Wellbeing Services for Patients with Upper GI Cancer
Authors: Coleman Claire , Hickey Wendy , White Cathy 
Published: December 2021

Abstract

Background
Cancer related distress has a major impact on quality of life. The psychosocial needs of patients post an oesophagectomy are significant and exacerbate the physical burden. The Upper GI MDT at our hospital aim to provide holistic patient centred care that equips patients mentally and physically for their treatment pathway. Formal or structured pyschoncology services are not routinely available to our patient cohort. The aim of the audit undertaken was to assess awareness of and subsequent engagement with available mental health services in patients undergoing a curative resection for oesophagogastric cancer.

Methods
Patients who underwent either a gastrectomy or oesophagectomy in the Upper GI Centre between Nov 2018 and May 2019 were included. They each received a questionnaire to complete anonymously. Responses were via prepaid post. Responses were collated and analysed.

Results
36 questionnaires sent out with 21 patients responding (Response rate 58%).
Average age:69 (age range 40-84).
18 of the 21 responses were male
Time diagnosed with cancer: 57% were between 12 to 18 months post diagnosis and 43% between 6 to 11 months.
Source of Information received: 43% reported verbal information provided and 38% reported written information was provided
Current engagement with Mental Health Services: National, Community, and Exercise programmes were used by a very small number of patients - 6 in total out of 21 respondents
Reasons for not engaging with Mental Health Services responses included ‘Not being interested or required' to ‘fearful' ‘No knowledge of service' to ‘Cant remember ' or ‘Plans to engage'
93% of respondents would recommend use of wellbeing or mental health services to someone with a diagnosis of an Upper GI Cancer
Suggestions for improvements varied from use of information packs, information on life post op and more guidance needed surrounding availability of current mental health supports

Conclusions
Psychosocial issues need to be addressed and there is a huge deficit in current service provision. Current service is not meeting service user needs and not empowering patients how best to manage mental burden and thus contribute to maximising treatment outcomes. National Cancer Strategy acknowledges lack of access for cancer patients to pyschoncology services. The Cancer Centre is awaiting appointment of a Pyschoncology Consultant and Team in the coming months. The Upper GI MDT will seek access to this service once available for their patient cohort. In interim use limited national and community resources available. Provide education to wider team members to standardise approach providing both written and verbal information on available mental health and well being services, embed mental health awareness into daily practice with encouragement for early patient intervention if cancer related distress evident. Re Audit after introduction of these measures.
P-OGC70 Chyle leak management and long-term survival post esophagectomy for oesophageal cancer
Authors: Askari Alan , Wong Joshua , Riaz Amjid 
Published: December 2021

Abstract

Background
Chyle leak can be a serious complication following oesophagal cancer resection. The aim of this study is to determine the rate of chyle leak, its management and impact on short-term surgical outcomes and overall long-term survival.

Methods
Analysis of a prospectively maintained database of patients undergoing esophagectomy for oesophagal cancer between January 2011 and April 2019 were undertaken. Short term and survival comparisons were made between the chyle leak and non-chyle leak groups.

Results
A total of 190 patients underwent esophagectomy at our hospital over this time period, of whom 3.7% (n = 7/190) had a chyle leak. The length of stay was longer in the chyle leak group (27 days, IQR 13-55 vs 12 days, IQR 11-14 days, P=0.001), they had a higher rate of return to theatre (42.9% vs 8.8%, P = 0.003) and higher rate of overall mortality (57.1% vs 35.0%, p = 0.039) compared to the non-leak group. They also experienced worse survival ( 9.0 months, 95% CI 5.5-12.4 vs 66 months, 95% CI 59.6-73.6, P = 0.001).

Conclusions
Chyle leak can occur in approximately 1 in 25 patients and is associated with prolonged intensive therapy unit stay, higher risk of return to theatre as well as a lower overall cancer survival.
P-OGC74 Effect of pre-operative anaemia on short-term outcomes following oesophagectomy: a 10-year retrospective cohort study
Authors: Chien Siobhan , Khan Khurram , Gall Lewis , Deboys Liam , Craig Carol , MacKay Colin , Macdonald Andrew , Forshaw Matthew 
Published: December 2021

Abstract

Background
Pre-operative anaemia is associated with increased length of hospital stay, requirement for allogenic blood transfusion, post-operative complications and mortality. Oesophagectomy is a complex procedure associated with significant physiological insult, thus pre-operative patient optimisation is imperative to improve clinical outcomes. This study aimed to determine the impact of pre-operative anaemia on short-term outcomes following oesophagectomy for benign and malignant disease.

Methods
A retrospective cohort study of all oesophagectomies performed in a single tertiary referral centre between 1 January 2010 and 31 December 2019 was performed. Patients were identified from a prospectively collected database and individual patient electronic records were interrogated. Patients were dichotomised into two groups, based on the most recent pre-operative haemoglobin. Patients with pre-operative anaemia (haemoglobin &lt;130mg/L in males and &lt;120mg/L in females) were compared to those without pre-operative anaemia. Patients with missing data were excluded from the study. Patients were followed up for a median of 32 months (IQR 18-66).

Results
Of 352 patients eligible for inclusion, 173 (49.1%) patients were anaemic immediately pre-operatively. Patients with pre-operative anaemia were older (66 vs. 64 years, p = 0.031), with a lower anaerobic threshold (11.7 vs. 12.3ml/min/kg, p = 0.011), and were significantly more likely to have undergone neoadjuvant chemotherapy (91.3% vs. 78.8%, p &lt; 0.001). Patient comorbidities and disease-related characteristics were similar between the two groups. Patients with pre-operative anaemia were significantly more likely to require post-operative blood transfusion (34.7% vs. 16.8%; p &lt; 0.001). However, pre-operative anaemia was not associated with increased post-operative complications, intensive care admission, length of hospital stay, or 30- and 90-day mortality rates following oesophagectomy.

Conclusions
Patients with anaemia immediately prior to undergoing an oesophagectomy were significantly more likely to require post-operative blood transfusion. However, pre-operative anaemia was not associated with an increased rate of post-operative morbidity or mortality. In addition, pre-operative iron transfusion is becoming increasingly utilised to minimise the incidence of pre-operative anaemia: this was not analysed in this study.
P-OGC81 The learning curve for robotic assisted abdominal phase in two stage oesophagectomy
Authors: McQuillan Patrick , Ahmed Salman , Navidi Mazair , Wahed Shajahan , Immanual Arul 
Published: December 2021

Abstract

Background
Robotic assisted oesophagectomy (RAO) is increasingly being utilised in the management of oesophageal cancer. RAO implementation into practice has an inevitable learning curve. As oesophagectomy usually involves at least 2 stages, a staggered approach to training and introduction of RAO can be done. A major advantage of this is that the surgeon can concentrate on overcoming the learning curve in one phase of the procedure at a time, whilst the remaining phase can be completed by an established technique.
This study looks at the learning curve of a robotic assisted abdominal phase for two-stage oesophagectomy compared to an open abdominal phase to achieve parity.

Methods
This study uses a prospectively maintained database to retrospectively analyse the abdominal phase of the first 17 RAO compared to the previous 20 open abdominal phase procedures. The cases are sequential, done by a single surgeon at a large UK oesophagogastric referral centre. Operating time, nodal count, and R0 rate were reviewed to determine the number of cases on the learning curve to reach parity with the open procedure.

Results
The open abdominal phase group had a similar age (65.6 vs 65.7), pre-op anaerobic threshold (13.9 vs 14.6 p = 0.3) but a higher BMI (mean 30.6 vs 24.6 p &lt; 0.05) then the RAO group. All cases were T3 adenocarcinoma except for 2 cases in the robotic group (one HGD and one T2 adenocarcinoma). No RAO cases were converted to open. The mean time for the abdominal phase in the open group was 175.4 minutes with an average nodal count of 32.9. After 8 robotic assisted cases the mean operating time decreased from 267 minutes to 197 minutes, which was when a non-significant difference to the open group (p = 0.094) became apparent. The mean nodal count in the first 8 robotic assisted cases was 29.5 and increased to 38.4 in the subsequent cases. All patients had a R0 resection.

Conclusions
The multi-phase nature of oesophagectomy allows for modular implementation of a robotic programme. We have found that the learning curve for robotic assisted abdominal is around 8 cases. This allows for parity to open abdominal phase to be achieved regarding operative time, nodal count and R0 resection.
P-OGC83 The Impact of Covid-19 on Malignant Upper GI Operations in England During 2020
Authors: Sandland-Taylor Laura , Jenkins Barbara , Beckingham Ian 
Published: December 2021

Abstract

Background
Due to the Covid-19 pandemic and the overwhelming number of patients requiring ITU due to serious Covid-19 infections, trusts throughout England reduced their operation numbers to reduce the burden on secondary care services. Whilst efforts were made to preserve cancer services in England, the Covid-19 burden still significantly impacted the provision of oesophagectomies and gastrectomies. The following research aims to look at the true impact of Covid-19 on operation numbers in England and compare these to the Covid-19 burden.

Methods
Data relating to operation numbers was taken from The Surgical Workload Outcomes Audit (SWORD) database. The SWORD database was interrogated for the years 2017 – 2020. A mean number of operations was calculated using the 2017-2019 data and compared to data from 2020. Operations performed and other demographic data was analysed regionally and compared to Covid-19 deaths throughout England. Covid-19 data was obtained from the national government dashboards.

Results
Results showed that there was a significant reduction in the number of operations performed in 2020 due to the Covid-19 pandemic. This was closely correlated with Covid deaths throughout England. Variations between centres were present throughout the UK, however the overall trend reflected more than a 40% reduction in gastrectomies and more than a 30% reduction in oesophagectomies, which equated to 1018 less gastrectomies and 490 less oesophagectomies performed in 2020. There was significant variation between centres, the impact on individual centres and oesophagectomy rates ranged from -0.8% reduction to a 100% reduction in operations carried out in 2020. Gastrectomies was similarly affected, varying between a 2.7% and 89.5% reduction in operations carried out in 2020.

Conclusions
Overall, despite efforts to preserve procedures, particularly for malignant disease, there was significant fall in operations performed throughout 2020. As a consequence of this, it is likely that patients requiring life saving or life extending operations did not receive their treatment. The data suggests that overall gastrectomies were worse hit than oesophagectomies across England. Variances in performance across the UK should be further analysed to allow better planning and resource allocation for future waves or future pandemics.
P-OGC88 Is Routine Contrast Swallow after Ivor-Lewis Oesophagectomy Required or Justified?
Authors: Mukhopadhyay Ishani , Krishnamoorthy Ashwin , McLaughlin Euan , Menon Vinod , Tan Lam Chin , Nilanjana Tewari 
Published: December 2021

Abstract

Background
Traditionally many Upper-GI cancer tertiary centres have carried out contrast swallow fluoroscopic studies as a routine after Ivor-Lewis “Two-Stage” Oesophagectomy. However, more recently studies have demonstrated the limited value of this test as a routine screening study. The primary outcome of our study was to assess the sensitivity of routine contrast swallow in identifying anastomotic leak post oesophagectomy and identify how the study changed management of these patients.

Methods
This was a single-centre retrospective study involving 2-observer data collection. Data was collected and analysed from clinical notes for all patients who underwent an Ivor-Lewis oesophagectomy for cancer between January 2011 to December 2020.

Results
A total of 220 patients were identified. Protocol at the centre was to obtain a routine contrast swallow in the Fluoroscopy department on the fifth post-operative day– which occurred in 211 patients (96%). A total of 19 (8.64%) patients were diagnosed with an anastomotic leak (clinically and/or radiologically), with contrast swallow imaging and/or computed tomography (CT). There was no correlation between incidence of leak and T stage (p = 0.38) and N staging (p = 0.22).
Only 3 of 19 anastomotic leaks were positively identified on contrast swallow study. All patients with anastomotic leak identified by contrast swallow study were asymptomatic i.e. “subclinical”. 2 patients were managed conservatively; one underwent endoscopic stent insertion. CT scan with oral contrast was the mode of diagnosis for 16 anastomotic leaks; where 10 patients underwent a CT scan following a normal contrast swallow study due to suspicious symptoms and 6 patients underwent expedited CT scans prior to Day-5 contrast swallow study due to presence of symptoms and limitation of fluoroscopy resources. The sensitivity of the Day-5 contrast swallow study was calculated to be 15.8% (CI 3.4, 39.6) with a specificity of 98.0% (CI 95.0, 99.5).

Conclusions
Our data reflects that routine contrast swallow study on Day-5 post Ivor-Lewis esophagectomy has a poor sensitivity in detecting anastomotic leak and may be falsely reassuring. The vast majority of patients had no change in management as a result of contrast swallow.
This adds to the growing body of evidence limiting the role of contrast swallow in this situation. We recommend that clinical judgement and use of CT and endoscopy be the surgeon’s prime tools in the diagnosis of anastomotic leak post oesophagectomy.