bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC06 The effect of surgical complications on long-term prognosis following oesophagectomy for oesophageal cancer
Authors: Broadbent Anna , Rahman Saqib , Grace Ben , Walker Robert , Noble Fergus , Kelly Jamie , Byrne James , Underwood Timothy 
Published: December 2021

Abstract

Background
Globally, oesophageal cancer incidence continues to increase. In recent years, surgical and oncological advancements have increased survival rates. Despite this, survival remains &lt;50% at five-years for patients treated with curative oesophagectomy. Previous data has suggested post-operative complications may play a role in long-term increased mortality in oesophageal cancer patients. This study aimed to examine the effect of adverse in-hospital events following oesophagectomy on the long-term prognosis for oesophageal cancer, including assessing the effect of cumulative complication burden using data from a single high-volume academic unit in the UK.

Methods
Retrospective analysis of patients undergoing oesophagectomy for oesophageal adenocarcinoma or squamous cell carcinoma was performed to assess the relationship between in-hospital events and long-term survival. Analysis was limited to patients who survived to 90 days post-oesophagectomy (n = 380). Complications were graded according to the Clavien-Dindo (CD) classification and the Comprehensive Complication Index (CCI). Survival was estimated using Kaplan Meier survival curves and multivariate cox-regression, adjusting for variables known to influence survival. The absolute magnitude of effect of complications on survival was assessed using the risk-adjusted population attributable fraction (PAF), which estimates the percentage improvement in survival if specified complications were removed.

Results
Complications occurred in 251 patients (66.1%). ≥CD3a complications (HR1.65, 95%CI 1.15-2.38, p &lt; 0.010) and unplanned critical care admissions (HR2.24, 95%CI 1.45-3.46, p &lt; 0.001) were independently associated with worse prognosis whereas pulmonary complications and anastomotic leak were not. A CCI &gt;30 was the optimum cut-point for OS (HR1.94, 95%CI 1.36-2.78, p &lt; 0.001), and after weighting to remove confounding bias median survival was shorter with CCI&gt;30 (28vs72 months, p &lt; 0.001). There was no difference in median survival when CCI&gt;30 occurred from major or multiple minor complications (31 vs 21 months, p = 0.096). The risk adjusted PAF for CCI&gt;30 was 8.5% (95%CI 3.6-13.1%).

Conclusions
Long-term survival following oesophagectomy for oesophageal cancer is significantly affected by major complications and unplanned critical care admissions. The cumulative effect of multiple post-operative minor complications is comparable to the effect of major complications on long-term survival from oesophageal cancer, and cause a substantial number of potentially preventable deaths, even in patients who survive to discharge.
P-OGC09 Evaluating the Availability of Services for Cancer Patients Following Surgical Resection of Esophago-Gastric Tumours
Authors: Al-Housni Ragad , Gossage James 
Published: December 2021

Abstract

Background
Upper gastrointestinal (UGI) cancers account for 11% of cancers in the UK, with oesophago-gastric cancers having the highest incidence rate in males. Since publication of the NHS Cancer Plan in 2001, mortality rates of oesophago-gastric cancer patients following curative surgery have been decreasing, causing an increased demand for services, particularly during follow-up post-operatively. Current guidelines recommend that patients are treated by specialised multi-disciplinary teams, involving both cancer nurse specialists and dieticians. However, the integration of these workers into patient care is still ongoing in UGI, with no national recommendations for trusts on the minimum requirements needed to run adequate services.

Methods
This was a retrospective observational study from October 2020 to April 2021. Cancer nurse specialists from all cancer trusts in England and Wales carrying out surgical resection of oesophago-gastric tumours were identified and contacted to complete a survey. The survey was divided into 4 main themes: the organisational setup of the trust, the follow-up of patients, the dietetic input and post-operative symptoms and survivorship.

Results
A total of 12 trusts out of 38 returned a completed survey. Differences were observed in the number of CNSs and UGI dieticians available across trusts. 50% of responders felt that the number of CNSs at their trust was not adequate to run efficient services for patients. In 42% of cases, the CNS was solely responsible for long-term follow-up of patients, up to 5-years in the majority of trusts. 11 trusts routinely follow-up patients with a dietician, integrated into MDT clinics. 75% of trusts had an associated patient group that could provide additional support to patients.

Conclusions
Differences in the availabilities of services and staff for oesophago-gastric cancer patients are present across trusts in England, which can lead to inequalities in patient care. Further longitudinal studies are needed to evaluate the impact of these differences on patient surgical outcomes and mortality.
P-OGC16 Minimally Invasive Oesophagectomy: Technique and learning curve over 10 years
Authors: May-Miller Peter , MacKenzie Hugh , Jenkins Nick , Mercer Stuart , Carter Nick , van Boxel Gijs , Knight Ben 
Published: December 2021

Abstract

Background
The use of minimally invasive oesophagectomy (MIO) in the treatment of patients with oesophageal malignancy has developed since its first description by Cuschieri in 1992, although mainstream uptake of this technique has not been forthcoming. Oncological resection margins were not compromised in MIO, whilst complications and two-year mortality rates improved in MIO compared to open oesophagectomy. The advantages of MIO compared to open surgery include the speed of recovery, improved return to baseline quality of life, better physical function and less pain. We present our experience of MIO including operative technique, tips, and learning curve.

Methods
160 patients underwent MIO at Portsmouth Hospitals University NHS Trust between August 2010 and December 2019. After June 2016 there was a significant change in surgical technique and pathway as outlined below and this time point has been interrogated.
Primary outcomes were operative duration (minutes) and both 30-day and in-hospital mortality. Secondary outcomes were length of in hospital stay (days), ITU stay, conversion to open surgery and complications.
We undertake laparoscopic abdominal phase and thoracoscopic or robotic assisted thoracic phase oeasophagectomy. Dual consultant operating is standard; and we work consistently with the same group of anaesthetists and theatre staff.

Results
82.5% of our 160 patients were male, median age was 67 years. Operative duration showed a steep learning curve over the first 10 cases followed by stabilisation to case 56 and then improvement. CUSUM analysis of the anastomotic leaks showed a change point at 53 cases - 30.8% vs 16.7% (p = 0.05). 30-day mortality is 1.88% and median length of stay 12 days (IQR12.75). Complications of Clavien-Dindo ≥III occurred in 35% and “perfect” outcomes in 21.25%. Conversion to open in 5.6% of cases but only 1 in the last 100 patients.

Conclusions
There is a learning curve associated with the adoption of a new technique. MIO can be performed safely and cost effectively with equivalent oncological outcomes with the advantage of improved quality of life. Oesophageal cancer is still poorly understood and we therefore must spend more thought on how best to give our patients good quality disease free life. Our outcome data is within existing published data and our prospectively collected data is thorough and meticulous. Though some complications are inevitable, small changes lead to marginal gains and add up to better outcomes.
P-OGC21 Patient perspectives on symptoms of importance and preferences for follow-up after major upper gastro-intestinal cancer surgery
Authors: Pucher Philip , Coombes Annie , Evans Orla , Taylor Joanna , Moore Jonathan , White Annabelle , Lagergren Jesper , Baker Cara , Kelly Mark , Kelly Mark , Gossage James , Dunn Jason , Zeki Sebastian , Byrne Ben , Andreyev Jervoise , Davies Andrew 
Published: December 2021

Abstract

Background
Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery.

Methods
An electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed.

Results
Among 362 respondents with a median follow-up of 58 months since surgery (range 3-412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Unsatisfied patients were more likely to have received shorter follow-up than 5 years (27% among unsatisfied patient vs. 60% among satisfied patients, p &lt; 0.001and were less likely to have seen a dietitian as part of routine follow-up (37% vs. 58%, p = 0.005).

Conclusions
This patient survey highlights preferences with regard to follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.
P-OGC34 Pandemic paradigms: Early outcomes of radical chemoradiotherapy for patients with operable oesophageal and oesophago-gastric junctional adenocarcinoma
Authors: Rupasinghe Sukitha Namal , Ninkovic-Hall George , Mckinney Rachel , Howes Nathan , Rao Rohith , Gunasekera Rohan , Grocock Christopher , Hartley Mark , Kaul Anil , Javed Muhammad Shafiq , Stephens Nathan 
Published: December 2021

Abstract

Background
The peak waves of the COVID pandemic necessitated a paradigm shift in surgical management of patients with oesophageal adenocarcinoma due to both pressure on services and high mortality rates for those with COVID undergoing surgery. The Association of Upper GI Surgeons (AUGIS) guidance on treating Upper gastrointestinal cancers in the COVID era made suggestions to treat operable adenocarcinomas using definitive/consolidation chemoradiation (DCRT) over standard neo-adjuvant chemotherapy (NAC) and our unit altered practice accordingly for a cohort of patients. For affected patients we monitored and audited clinical outcomes and the initial results from this are presented here.

Methods
Patients with oesophageal or oesophago-gastric junctional (O/OGJ) adenocarcinoma with potentially curative disease where initial management was altered from a treatment path which would have included surgery (with or without neoadjuvant therapy) to DCRT discussed at our regional multidisciplinary team (MDT) meeting between 1st February-1st June 2020 were included. Patient demographics, investigations, treatment given and clinical outcomes were prospectively recorded.

Results
31 Patients with operable adenocarcinoma of O/OGJ had treatment altered to DCRT (mean age 65.4, [range 43 – 79]), 28 (90%) Male. 1 patient deteriorated prior to starting, leaving 30 who completed DCRT. Of these 4 patients had already had NAC prior to DCRT.
Follow up was for a median of 8 (range 4-8) months following start of treatment.
Post- vs pre-treatment FDG-PET imaging demonstrated a significant reduction in the mean maximum standardized uptake value (SUVmax) (p = 0.003, Sign test), in all but 3 patients.
11 patients had DCRT alone, (all alive at the time of data collection), of whom 3 patients had no sign of tumour.
19 (56%) patients proceeded to salvage oesophagectomy at a median of 15(range 10-25) weeks after completion of DCRT. 42% of these patients had a complete pathological response to treatment. There was a 5% perioperative mortality rate for this group and 1 patient was found to be unresectable on the day of surgery.
At the time the data was reviewed overall survival of the entire cohort was 91%, 56% of whom had no sign of residual or recurrent disease.

Conclusions
A disease free survival of 56% compares poorly with the literature at the 3-month interval. The long-term follow-up of these patients will only be apparent in the coming months and years. This data does not support the use of this modality in the future and alternate treatment plans should be devised for future pandemics.
P-OGC36 Staging Laparoscopy in Oesophago-gastric cancers; A highly selective approach and its impact on patient outcome during COVID 19
Authors: Koroma Paul , Chaudhury Madhu , Ali Raza Shehrazi S , Ball Christopher , Turner Paul , Ward Jeremy , Pursnani Kishore , Shetty Vinutha 
Published: December 2021

Abstract

Background
Staging laparoscopy is performed in all Oesophago-gastric cancer patients suitable for radical treatment with tumour staged ≥T2 prior to neoadjuvant chemotherapy. In response to COVID 19 pandemic, on 25th March 2020, the joint statement issued by the Royal College of Surgeons and AUGIS advised all laparoscopic procedures should be avoided due to the risk of virus transmission associated with aerosol-generating procedures. In accordance with the guidance, a more selective approach on who underwent a staging laparoscopy was followed. This audit explores its impact on patient outcome comparing data from pre COVID period with the COVID period.

Methods
Retrospective and prospective data was collected for 24months on all OG cancer patients from 25th March2019 to 24th March2021. ‘Pre COVID’ period was defined as 25th March 2019 to 24th March 2020 and ‘COVID’ period was defined as 25th March 2020 to 24th March 2021. All patients with Oesophago-gastric cancer with MDT cancer staged ≥T2, suitable for neoadjuvant chemotherapy were included. Patients with tumour staged &lt;T2 and or diagnosed with squamous cell carcinoma involving upper or middle third of oesophagus were excluded. Fishers Exact model using SPSS V24 was used to identify any statistically significant differences between the 2 groups.

Results
Pre-COVID Period: 80patients underwent staging laparoscopy. Of these, 9patients(11.6%) with tumour staged as ≥T3 were declined curative surgery due to advanced disease(n = 2), metastatic disease(n = 3) or both(n = 4). In total, 40patients underwent curative surgery and there were 0 open/close laparotomies.
COVID Period: Of the 79patients suitable for staging laparoscopy, only 7patients(8.7%) underwent laparoscopy. Of these, 3patients(3.8%) with tumour staged as ≥T3 were declined curative surgery due to advanced disease(n = 2) and metastatic disease(n = 1). In total, 33patients underwent curative surgery and only 1patient had an open/close laparotomy due to a liver metastases. No statistically significant difference was found p = 0.0913

Conclusions
Staging laparoscopy is a useful tool for accurate staging of Oesophago-gastric cancers. It helps avoid unnecessary open and close laparotomy due to advanced disease and also allows us to assess patient fitness to major surgery. During the pandemic, the number of staging laparoscopies performed declined significantly but with no statistically significant difference to patient outcome. Thus we conclude, the COVID 19 pandemic has enabled us to have a selective approach to performing staging laparoscopy in Oesophago-gastric patients with advanced disease staged ≥T3 only.
P-OGC45 Could lymphatic, vascular or perineural invasion status improve clinical staging prior to oesophagectomy?
Authors: Chmelo Jakub , Hardy Kiera , Brown Joshua , Prasad Pooja , Phillips Alexander W 
Published: December 2021

Abstract

Background
Unimodal treatment of oesophagogastric cancer (OGC) with surgery only is currently reserved for patients with early disease. Presence of vascular (VI), perineural (PNI) or lymphatic vessel invasion (LI) in pathological samples have been shown to be negative prognostic indicators of survival. These factors have been found to be associated with more advanced disease. Staging of OGC has limitations and in neoadjuvant naive populations it has been shown to be imperfect. It is unknown whether VI, PNI or LI could play any role during the staging process.

Methods
Patients with early disease (cT2 or less and cN0) who underwent unimodal treatment of their oesophageal or junctional cancer with oesophagectomy between 2010 and 2019 in a single centre were included in this study. Therelationship between presence of LI, VI and PNI on pathological samples with incorrect staging/upstaging indicating locally advanced disease (defined as pT3+ or pN+) was studied using logistic regression model.

Results
There were 128 patients included. 26 patients (20%) were upstaged to pT3+ or pN+. LI, VI and PNI were present in 18%, 11% and 8% respectively. The presence of LI and clinical T stage were independently predictive of incorrect staging/upstaging in multivariable logistic regression analysis. LI (OR 12.5 95%CI 3.7-42.8, p &lt; 0.001) and cT2 (OR 5.9 95%CI 1.5-23.2, p = 0.01).

Conclusions
These results indicate that the presence of LI from pathological samples is a strong independent prognostic factor of incorrect staging which would normally favour neoadjuvant treatment. The presence of LI suggests aggressive disease. Further studies should concentrate on the possibility of obtaining LI status from preoperative biopsies or endoscopic mucosal resection samples. This staging information could play an important role in deciding whether neoadjuvant therapy is indicated in patients staged as early disease.
P-OGC48 Definitive Chemoradiotherapy versus Neoadjuvant Chemoradiotherapy Followed by Radical Surgery for Locally Advanced Esophageal Squamous Cell Carcinoma: Systematic Review and Meta-analysis
Authors: Kamarajah Sivesh K , Evans Richard , Gossage James , Griffiths Ewen , Pucher Phil 
Published: December 2021

Abstract

Background
Debate exists surrounding definitive chemoradiotherapy (dCRT) over neoadjuvant chemoradiotherapy and surgery (nCRS) as a primary treatment for esophageal squamous cell carcinoma (ESCC) owing to the heterogeneity in the quality of current evidence. This study aimed to compare long-term survival of dCRT with nCRT for ESCC from high-quality studies.

Methods
This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 23rd July 2021. Primary outcome was overall survival (OS) and secondary outcomes were disease-free survival (DFS) and recurrence rates. A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs).
Results
This review included ten high-quality studies including 14,092 patients, of which 30% received nCRT. Three studies were randomized controlled trials (RCT), six studies were single-center. dCRT and nCRT regimens were reported in six studies and surgical quality control were reported in two studies. Outcomes for OS and DFS were reported in eight and three studies, respectively. nCRT had significantly longer OS (HR: 0.68, CI95%: 0.54 - 0.87, p &lt; 0.001) and DFS (HR: 0.50, CI95%: 0.36 - 0.70, p &lt; 0.001) than dCRT.

Conclusions
nCRS followed by planned esophagectomy appears to remain the optimum curative treatment regime in patients with loco-regional ESCC. Thus, surgery remains an integral component of the management of patients with ESCC. As adjuvant and immunotherapy treatment regimens develop, ongoing prospective assessment of the role of radiotherapy in combination with modern treatment modalities should be studied
P-OGC54 Economic cost utility analysis of stage directed oesophageal adenocarcinoma treatment
Authors: Robinson David , Powell Arfon , Lewis Wyn 
Published: December 2021

Abstract

Background
Oesophageal Cancer (OC) treatment levies substantial financial burden on Health Services and Best Supportive Care (BSC) outcomes are poor. Potentially Curative Surgery with or without Chemotherapy is offered to patients with locally advanced disease and this study aimed to examine treatment costs related to life-years gained in patients having potentially curative treatment (oesophagectomy) and those receiving Best Supportive Care (BSC).

Methods
Consecutive 179 patients diagnosed with potentially curative adenocarcinoma of the oesophagus between 2010 and 2017 were classified according to treatment modality by intention to treat (surgery vs. neoadjuvant/adjuvant chemotherapy). Cost calculations for one-year’s treatment from referral were made according to network diagnostic, staging, and treatment algorithms. Primary outcome was Overall Survival (OS).

Results
OC median survival after BSC is reported to be 3 months costing £4391 compared with Oesophagectomy median survival (all stages) of 44 months costing an average of £26,652 for one year’s treatment: BSC cost per QALY £92,448 compared with £12,207.20 for potentially curative surgery. Cost incurred for stage I OC was £25,153.09, stage II £26,795.17, stage III £28,781.81, and stage IV £28,592.64. Based on these values, the cost per Quality Adjusted Life Year (QALY) for stage I OC was - £8,361, II - £12,319, III - £21,998 IV - £35,011.

Conclusions
Potentially curative treatment that included oesophagectomy improved OS fifteen-fold compared with BSC and was cost effective at national thresholds of readiness to pay per QALY.
P-OGC60 Predicting the risk of venous thromboembolism during neoadjuvant therapy for oesophagogastric cancer
Authors: Calabrese Michele , Chmelo Jakub , Prasad Pooja , Brown Joshua , Wallace Lauren , Phillips Alexander 
Published: December 2021

Abstract

Background
Locally advanced oesophageal cancer is usually treated with neoadjuvant treatment (NAT) followed by surgery. Venous thromboembolism (VTE) is a recognised complication in these patients. Those who develop VTE may have an inferior vena cava filter placed prior to surgery to reduce the risk of further complications. This study aimed to identify specific risks for VTE during (NAT) for oesophagogastric cancer (OGC) and whether this increases postoperative morbidity.

Methods
Patients undergoing NAT for OGC followed by surgery at a single high-volume centre between January 2015 and June 2020 were identified from a prospectively maintained database. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for the development of VTE as well as the association between diagnosis of VTE and morbidity.

Results
The incidence of VTE in this cohort was 6.7% (27/406). Independent risk factors for developing VTE in multivariable analysis were BMI – OR 1.093 (p = 0.045) and age – OR 1.067 (p = 0.019). Type of chemo(radio)therapy regimen used, pT, pN stage, previous history of ischaemic heart disease or being an active smoker at diagnosis was not associated with VTE occurrence. Diagnosis of VTE during neoadjuvant treatment was not associated with a higher risk of developing a serious postoperative complication (Clavien-Dindo grade III and above) (p = 0.699).

Conclusions
Patients with a raised BMI or older age are at higher risk of developing VTE during NAT for OGC. These patients must be appropriately counseled on the higher risk of VTE prior to commencing NAT. However, the development of a VTE does not appear to confer any additional post-operative complication risk.