bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC61 Long-term outcomes following minimally invasive oesophago-gastric resection for oesophageal and gastro-oesophageal junctional cancer: a single center experience
Authors: Orabi Amira , Chillarge Gauri , Di Mauro Davide , Veeramootoo Darmarajah , Mitchell keith , Reece-Smith Alex , Manzelli Antonio , Daneshmend Tawfique , Wajed Shahjehan 
Published: December 2021

Abstract

Background
Oesophago-gastric surgical resection for cancer has been associated with high morbidity and poor long-term prognosis. Medical advances have led to improvements and the con-current development of videoscopic technology enabled a paradigm shift in many areas of surgical practice. Between 2004 - 2010, a three-stage total (thoracoscopic/laparoscopic) minimally invasive oesophagectomy (MIO) with curative intent, was offered to all patients diagnosed and treated for esophageal and oesophago-gastric junctional (GOJ) cancers as an alternative to open surgery at our specialist Centre. Previously we have reported on safety, feasibility, short term outcomes, quality of life and complication profiles; this study now reports on eventualities at least a decade after surgery.

Methods
All patients who underwent MIO (laparoscopic/thoracoscopic) three-stage procedure from April 2004 to January 2010 for oesophageal and GOJ malignancy were identified. A retrospective analysis of patients’ records in conjunction with an updated clinical follow-up was carried out. Patients’ demographics, oncologic stage (in accordance to the American Joint Committee on Cancer 6th and 7th Edition), overall survival, 5-year and 10-year survival, recurrence rate and disease-free survival (DFS) were retrospectively analyzed. Statistical analysis was conducted using Prism version 9.1.0 (GraphPad Holdings LLC, California).

Results
A total of 120 patients (majority of which were males – 84.2%) were included in the study. Mean age was 66.7 ± 0.74. 43 patients. In-hospital death occurred in 4 (3.3%) patients. Over the time period, 25 (20.8%) patients were alive. Of those deceased Sixty-six (69.5%) succumbed to cancer, and 29 (30.5%) died from other causes. 43 patients (35.8%) were alive at 5 years and 33 (27.5%) at 10 years. Excluding those with Stage 0 disease, the 5-year and 10-year survival rates were 32.4% and 24.1%, respectively. The recurrence rate was 63 (52.5%) patients and the overall median DFS was 24 months (IQR, 186); Stage 3 patients had the shortest DFS (p &lt; 0.0001).

Conclusions
Survival and disease-free survival in this historical cohort of patients who underwent a total MIO for cancer is comparable to published data from similar open series of that era as well as modern reported outcomes from specialist centers. Benefits of a minimally invasive approach can therefore be realized without compromise to oncological and overall prognosis.
P-OGC62 Home Enteral Tube Feeding: The Patient’s Perspective. Are we delivering an effective dietetic service?
Authors: Forde Neasa , White Cathy 
Published: December 2021

Abstract

Background
Long term feeding tubes, managed independently at home have been shown to improve quality of life scores and in general are considered to be well tolerated. Beaumont Hospital has seen an increase in the number of patients referred for home enteral feeding (HEN) prior to neoadjuvant treatment for oesophagogastric (OG) cancer. We aimed to gain an insight into the supports, experiences and challenges encountered by these patients in an emerging service.

Methods
A retrospective qualitative study using data from 2019-2020. A questionnaire was adapted from a multicentre Irish study in 2017. Patients with OG cancer for treatment with curative intent, that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Patients were provided with a questionnaire via post. Data was analysed using Microsoft Excel.

Results
Response rate was 82% (14 of 17questionnaires). Mean age 60.4yrs (SD 11.7). 93% male (N = 13). In 36% (N = 5) tube feeding duration was &lt; 3months and 3-6months duration in 43% (N = 6).

Conclusions
Overall positive feedback was received from patients regarding living with a feeding tube, confirming the important and impactful role of HEN. Priorities for service improvements: improved discharge information and resources may help reduce use of unreliable resources e.g. develop HEN discharge booklet to keep all relevant information in one accessible location, development of video education resources for consolidation of knowledge. Aim to provide more structured follow up with clear plans and channels of communication outlined for the patient. Quality improvement work with surgical team to reduce complication rate with feeding tubes.
P-OGC71 Five positive lymph nodes are a significant negative indicator of survival in Oesophago-Gastric Cancer surgery: an 8-year study
Authors: Parker Tamsin , Riaz Amjid , Askari Alan , Ebrahim Ahmad , Tang Cheuk-Bong , Lorenzi Bruno , Jayanthi Naga Venkatesh 
Published: December 2021

Abstract

Background
Number of positive lymph nodes involved is an important prognostic indicator in Oesophago-Gastric cancer survival post surgery. We present an 8 year study examining the number of lymph nodes involved and its impacts on long term cancer survival and in particular to determine whether there is a threshold after which survival is significantly worsened.

Methods
A prospectively maintained single-institution database containing data from all patients from Jan 2012 to Dec 2020 was analysed. Survival analyses were undertaken to determine the association between lymph node positivity and survival.

Results
A total of 430 patients underwent surgery for gastro-oesophageal cancer (oesophagectomy: n = 311, 72.3%; gastrectomy n = 119, 27.7%) of which 80.2% were male and the median age was 68 years old (IQR: 61-74). A median of 23 nodes were examined (IQR 18-33) and a median of one lymph node was positive for cancer (IQR 0-3 lymph nodes). The majority of patients (59.3%) had a T3 tumour, 24.0% had T2, and 12.1% had a T1 tumour. Over a median follow up of 30 months (IQR 13-61), 61.2% of the study population were alive. Kaplan Meier analyses demonstrated that patients who had five or more positive nodes had a survival of 36.3 months (IQR: 24.4-48.3 months) compared to those with four or fewer nodes (45.8 months, IQR: 27.6-64.1 months, p &gt; 0.001). Survival did not worsen further with a higher number of positive nodes.

Conclusions
This study shows that having five or more positive lymph nodes significantly worsens Oesophago-gastric cancer survival. These results may suggest that from the threshold of 5 positive nodes, OG cancer behaves as a systemic disease and thus impact on adjuvant treatment strategies.
P-OGC75 Use of a single visit combined contrast enhanced CT with PET (PET/CeCT) in the staging of oesophageal and gastric cancers during the COVID-19 pandemic – is it adequate, timely and cost effective?
Authors: Jones Michael , Higgs Simon , Dwerryhouse Simon , Markos Vikas , Mason Karen , Lyburn Ian 
Published: December 2021

Abstract

Background
COVID-19 has had a massive effect on service provision within the NHS. At our regional oesophagogastric centre the usual protocol for workup of new cancers involves endoscopy, with separate imaging in the form of a contrast enhanced CT, and standard PET/CT (PET with non-contrast CT). To reduce exposure to the hospital environment and potential infection, a group of patients underwent combined PET/CeCT imaging in a single hospital visit. The aim of this project was to assess whether the combined scans were of adequate diagnostic quality, cost efficient, and if they reduced time to treatment.

Methods
We retrospectively identified all patients who had been discussed in the Upper GI cancer MDT in 2020 at our trust. To be included in the study, the diagnosis must have been made during 2020. Using our MDT records, clinical letters, endoscopy and radiology systems, we obtained dates of investigations along with types and dates of treatment. Data was tabulated in Microsoft Excel. Upper GI consultant radiologists advised on diagnostic quality and technicality of scans, and trust finance directors were able to advise on costs of imaging.

Results
211 new oesophageal or gastric cancers were discussed in our MDT in 2020. 33 patients had PET/CeCT, these took place between March and October. 178 patients had separate imaging. Median time from diagnostic OGD to PET/CeCT was 8 days vs 16 days to final imaging in the separate group. Median time from diagnostic OGD to treatment start date was 36 days for PET/CeCT vs 41 days in the separate group. No PET/CeCT’s required repeating due to poor diagnostic quality. At our trust PET/CeCT had a cost saving of £88.58 compared to separate scans.

Conclusions
Our experience is that PET/CeCT allows accurate radiological staging of oesophagogastric cancers with a single patient visit, at more convenience to the patient and with reduced potential exposure to COVID-19. Patients were able to complete their cancer staging and start their treatment pathway sooner than with separate scans. This comes with a significant cost saving to the NHS per patient, which at our trust scaled up to a potential £18,000 in one year. Our MDT is now planning to perform radiotherapy planning CT images in the same episode.
P-OGC77 Why curative treatment rates are so low for stage I/II Oesophago-gastric cancer in the West of Scotland? – A five year review
Authors: Khan Khurram , Gall Lewis , Miller Gillian , Macdonald Andrew , Craig Carol , MacKay Colin , Forshaw Matthew 
Published: December 2021

Abstract

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

Methods
The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2015 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analyzed and the reason for the non curative treatment recorded.

Results
260 patients (mean age 78.3 ± 9 years; 114 (43.8%) female) were identified. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-7). There were 159 (61.2%) oesophageal cancers, 196 (75.4%) adenocarcinomas and 174 (66.9%) were Stage II cancers. Formal CPEX fitness was assessed in only 20 patients (7.7%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 216 (83.1%)); patient declined curative treatment (n = 17 (6.5%)); disease progression (n = 16 (6.2%)) and identification of synchronous cancers (n = 9 (3.5%)).

Conclusions
Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.
P-OGC80 The effect of COVID -19 on new diagnosis oesophagogastric cancer patients in the UK: A single-centre experience
Authors: McQuillan Patrick , Ahmed Salman , Navidi Maziar , Hayes Nick , Wahed Shajahan , Immanual Arul , Phillips Alex 
Published: December 2021

Abstract

Background
Covid-19 has had a devastating global impact and resulted in over 4.4 million directly attributed deaths. The UK entered lockdown in March 2020, redistributing its medical workforce and resources. Early estimations suggested at least 4700 extra cancer deaths at 5 years if there was a 3-month delay to surgery. Delays to diagnosis and treatment for osophagogastric (OG) cancers can be particularly detrimental to survival.
The aim of this study is to assess the impact of Covid-19 on new cancer referrals to a centralised UK OG cancer centre, including presentation, decision making and treatment.

Methods
Patients with OG cancer referred to a tertiary, high-volume centre between March 2019 and March 2021 were reviewed. Patients were stratified into Pre-covid (March 2019-March 2020) and Covid (March 2020-2021) cohorts. Number of new referrals, clinical stage, treatment decision, and time to treatment were compared for gastric adenocarcinoma (GA), oesophagogastric-junction adenocarcinoma (OGJA), oesophageal adenocarcinoma (OA) and oesophageal SCC (OSCC).

Results
There was an 11% reduction in new cancer referrals (485 vs 431). GA, OGJA and OA did not have significant change in treatment intent, although there was a significant increase in the decision for definitive non-surgical treatment of OA (P = 0.046). GA and OA patients had a small, but significant increase in mean clinical stage at presentation (P &lt; 0.05). There was no increase in time to treatment for GA, OGJA and OA. A significantly higher proportion of OSCC patients were given curative intent treatment in the Covid-19 cohort (P = 0.0006) however, this was accompanied with an increased time to treatment commencement (35.8 days vs 27.9 days P = 0.0198).

Conclusions
This high-volume centre has seen a reduction in new cancer referrals since the first UK lockdown. This was associated with a small, but significant, increase in clinical stage of GA and OA at presentation. This may represent an early indication of excess oesophagogastric cancer deaths due to the impact of Covid-19. This data also confirms initial results showing that oncological decisions were not compromised, although Covid-19 remains a dynamic challenge.
P-P06 Ward based goal directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: a feasibility randomised controlled trial [ISRCTN 36077283]
Authors: Froghi Farid , Soggiu Fiammetta , Ricciardi Federico , Vindrola-Padros Cecilia , Floros Lefteris , Martin Daniel , Filipe Helder , Varcada Massimo , Gurusamy Kurinchi , Bhattacharya Satyajit , Fanshawe Angela , Dolcea Bogdan , Mathur Pawan , Davidson Brian 
Published: December 2021

Abstract

Background
Goal directed fluid therapy (GDFT) based on cardiac output assessment has been shown to reduce complications and improve survival for people undergoing major general surgery. There are no reports of cardiac output evaluation being used to optimise the fluid administration for patients with acute pancreatitis who are in a general surgery admission ward.

Methods
The trial protocol has been published. 50 patients with acute pancreatitis were recruited, consented and randomly allocated to either ward-based GDFT with intravenous (IV) fluids administered based on stroke volume optimisation or standard ward care but with blinded cardiac output evaluation for 48 hours following hospital admission.

Results
Over a period of 20 months 50 of 142 screened patients were recruited demonstrating that it was feasible to recruit into a randomised trial of this nature in ward patients with acute pancreatitis. 36 (72%) completed the allocated 48 hours of goal directed fluids with 10 (20%) discharged within 48 hours and 4 withdrawals (3 GDFT and 1 SC). Baseline characteristics of the groups were similar with only 3 participants having severe disease (6%, 1 GDFT, 2 SC). Similar volumes of IV fluids were administered in both groups (GDFT 5465 (1839) ml, SC 5211 (1745) ml). GDFT group had a lower heart rate, blood pressure and respiratory rate and improved oxygen saturations. GDFT was not associated with any harms. Complications of AP appear to be similar as was duration of stay in intensive care. Length of hospital stay was 5 (2.9) in GDFT and 6.3 (7.6) in SC groups.

Conclusions
Ward GDFT is feasible and shows a signal of possible efficacy in acute pancreatitis in this early-stage study. A larger multi-site RCT is required to confirm clinical and cost effectiveness.
P-P09 Salvage transgastric necrosectomy as a part of a step-up approach to managing acute necrotising pancreatitis
Authors: Ngan Franko Shing Fun , Sarkar Srishti , Arshad Ali , Maher Ben , Tehami Nadeem , Stevens Claire , Takhar Arjun 
Published: December 2021

Abstract

Background
The use of EUS (endoscopic ultrasound) guided drainage with endoscopic LAMS (lumen apposing metal stent) necrosectomy is an emerging treatment option for walled-off pancreatic necrosis (WOPN) secondary to acute severe pancreatitis. It can delay or remove the need for surgical necrosectomy, which can be associated with high morbidity and mortality. However, the endoscopic approach is not always successful due to a multitude of factors and salvage transgastric necrosectomy can be performed using the tract created by the LAMS to achieve internal drainage and remove necrotic pancreas.

Methods
We describe our unit’s experience in managing WOPN in two patients. We suggest a treatment pathway of WOPN which includes a step-up approach including salvage transgastric necrosectomy in patients where multiple endoscopic necrosectomies and washouts have failed.

Results
Two patients, aged 67 and 69, were admitted as intensive care transfers for gallstone and alcohol pancreatitis respectively. They underwent a step-up approach to treat their infected WOPN, starting with the deployment of LAMS and endoscopic necrosectomy. They both showed brief clinical improvement after repeated endoscopic necrosectomy but further imaging showed ongoing large collections that could not be treated endoscopically. Both patients underwent successful transgastric open necrosectomy where necrotic pancreatic tissue was accessed surgically through the already created cyst-gastrostomy. This had the advantage of internal drainage of the collection into the stomach without the need for external surgical drains.

Conclusions
The emphasis in the treatment of WOPN has shifted to minimally invasive percutaneous or endoscopic drainage modalities. Endoscopically inserted LAMS may not always achieve definitive drainage of the WOPN but should be employed in the first instance as they are associated with reduced morbidity and mortality compared to surgery. Ultimately, open necrosectomy with washout remains the definitive management strategy in the step-up approach. We believe that the trans-gastric open necrosectomy approach can be used successfully in patients where the minimally invasive approach has failed.
P-P34 Impact of an Enhanced Recovery After Surgery Protocol on Short-Term Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy
Authors: Raza Syed Soulat , Nutu Anisa , Powell-Brett Sarah , Boteon Amanda Carvalheiro , Hodson James , Abradelo Manuel , Dasari Bobby , Isaac John , Chatzizacharias Nikolaos , Marudanayagam Ravi , Mirza Darius , Roberts Keith , Sutcliffe Robert 
Published: December 2021

Abstract

Background
In an effort to improve postoperative recovery and reduce complications, enhanced recovery after surgery (ERAS) pathways have been introduced across a range of surgical disciplines. The demographics of patients being considered for PD have evolved over recent decades, with older patients undergoing increasingly more complex procedures. The feasibility and benefits of an ERAS protocol for elderly patients undergoing PD is debated, a recent study suggesting that age over 70 years is an independent risk factor for protocol failure . Existing studies on ERAS after PD in elderly patients are limited by small sample sizes and failure to include a pre-ERAS control.

Methods
830 consecutive patients who underwent PD between January 2009 and March 2019 were divided according to age: elderly (≥75 years) vs. non-elderly patients (&lt;75 years). Within each age group, cohort characteristics and outcomes were compared between patients treated pre- and post-ERAS (ERAS was systematically introduced in December 2012). Univariable and multivariable analysis were then performed, to assess whether ERAS was independently associated with length of hospital stay (LOS).

Results
Of the entire cohort, 577 of 830 patients (69.5%) were managed according to an ERAS protocol, and 170 patients (20.5%) were aged ≥ 75 years old. Patients treated post-ERAS were significantly more comorbid than those pre-ERAS, with a mean Charlson Comorbidity Index of 4.6 vs. 4.1 (p &lt; 0.001) and 6.0 vs. 5.7 (p = 0.039) for the non-elderly and elderly subgroups, respectively. There were significantly fewer medical complications in non-elderly patients treated post-ERAS compared to pre-ERAS (12.4% vs. 22.4%; p = 0.002), but not in elderly patients (23.6% vs. 14.0%; p = 0.203). On multivariable analysis, ERAS was independently associated with reduced LOS in both elderly (14.8% reduction, 95% CI: 0.7-27.0%, p = 0.041) and non-elderly patients (15.6% reduction, 95%CI: 9.2-21.6%, p &lt; 0.001), with the effect size being similar in each group.

Conclusions
ERAS protocol can be safely applied to patients undergoing pancreaticoduodenectomy irrespective of age. ERAS is associated with a significant reduction in postoperative LOS in elderly and non-elderly patients, despite higher comorbidity in the post-ERAS period.
P-P44 Clinical outcomes of consecutive patients undergoing distal pancreatectomy over the last decade at a high volume tertiary pancreatic surgery unit
Authors: Patel Bhavik , Fristedt Richard , Hamady Zaed , Takhar Arjun , Armstrong Tom , Hilal Mohammad Abu , Karavias Dimitrios , Arshad Ali 
Published: December 2021

Abstract

Background
Distal pancreatectomy (DP) enables resection of lesions in the body and tail of the pancreas. Over the past decade, the Laparoscopic approach has become frequently employed. There remains scarce outcome data available following laparoscopic distal pancreatectomy over a long time period from high volume centres. Postoperative pancreatic fistula (POPF) remains the main source of morbidity and mortality after DP. The causes of POPF are multifactorial and poorly understood. The optimal method of pancreatic stump closure is still debated with variation in clinical practice.

Methods
All patients that underwent distal pancreatectomy at a UK tertiary pancreatic surgery centre between January 2011 and January 2021 were identified and clinical outcomes examined. Patients undergoing completion pancreatectomies were excluded. Clinical, pathological and surgical data for the included patients was retrospectively collected from the electronic patient record. Clinically significant POPF was defined as Grade B or C as per the ISGPF guidelines. For stapled stump closure, the Compression Index (CI) was calculated using closed staple height (mm) divided by the pancreatic thickness (mm). High and low CI was defined around the median.

Results
233 patients (n = 90 open and n = 143 laparoscopic) were included in the final analysis. The laparoscopic approach was associated with comparable morbidity and significantly lower blood loss, shorter operative time and shorter length of stay. There were no significant differences in age, sex, final histology, closure technique, or ASA Score of 3 or more amongst patients with clinically relevant POPF (CR-POPF). The POPF group had a significantly higher BMI, drain duration and readmission rate. CI data was available for 78 cases (range 0.04-0.21). There was no significant difference in low vs high CI for patients with CR-POPF.

Conclusions
Laparoscopic distal pancreatectomy is associated with favourable clinical outcomes in this series. Stapled vs sutured closure of the pancreatic stump offered equivocal outcomes with relation to POPF. POPF continues to have a significant impact on a clinical recovery as evident from longer drain duration and high readmission rates. Further research is required to try to establish methods for reducing the incidence of POPF after distal pancreatectomy.