bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC O06 - Socioeconomic Health Inequality in Oesophago-gastric Cancer in a Single Tertiary Centre: On Behalf of Greater Manchester OG Unit
Authors: Thomson Jack , Tarazi Munir , Farnworth Christine , Powell Arfon , Sultan Javed 
Published: November 2024

Abstract

Background
Oesophagogastric cancer (OGC) 5-year survival is poor (15%). Only 34% of patients are considered for potentially curative treatment, which is associated with a 41% chance of survival. In other cancer, deprivation is associated with poor outcomes. This study aims to determine the association between deprivation, tumour and treatment intent (TI), and 5-year all-cause mortality (M) in OGC.

Method
This retrospective cohort study analysed patients newly diagnosed with OGC (adenocarcinoma or squamous cell carcinoma) across Greater Manchester between January 2018 and January 2023. TI was defined as the treatment pathway, at completion of staging investigations, either curative (pathway to resection or definitive chemoradiotherapy) or palliative (best supportive care, palliative chemotherapy or radiotherapy). Statistical analysis encompassed methods such as binary logistic regression, Cox proportional hazards models and Kaplan-Meier survival curves with adjustments made for age, gender, and clinical stage. IMD scores were grouped from deciles into quintiles leaving 5 groups, with IMD1 representing the most deprived.

Results
3027 patients were included (2102, 69.4% males). Patients in IMD1 were diagnosed 4 years younger than in IMD5 (most affluent) (median age 70 (IQR=17) vs 74 (IQR=16), p&lt;0.001). There was a higher proportion of deprived patients (32.9% IMD1 vs 15.3% IMD5, p&lt;0.001). The proportion of stage 4b disease in IMD1 compared with IMD5 was not different (406 (40.7%) vs 174 (37.5%), p=0.081). The median survival was lower in IMD1 compared with IMD5 (0.81 vs 0.90 years, p=0.074). Following adjustment for confounders IMD1 was associated with a poorer overall survival when compared with IMD5 (HR 1.16, CI[1.02-1.32],p=0.020).

Conclusion
This study highlights a significant health inequality in the outcomes of OGC. Poorer outcomes in the most deprived group were independent of tumour stage, gender and age. Urgent measures to address socioeconomic health inequalities need to be instigated.
BN O03 - Pooled two-year results of the novel RefluxStop implantable device in management of gastroesophageal reflux disease in Germany: Retrospective analysis
Authors: Elshafei Moustafa , Lehmann Thorsten 
Published: November 2024

Abstract

Background
The most common gastrointestinal disorder globally is gastroesophageal reflux disease (GERD). Standard-of-care treatments for GERD are medical therapy, via proton pump inhibitors (PPIs), and traditional antireflux surgery (i.e., Nissen fundoplication). Unfortunately, PPI therapy is associated with medication irresponsiveness in up to 40% of cases and Nissen fundoplication results in significant rates of postoperative adverse events (AEs), such as postoperative dysphagia. Notably, patients with large hiatal hernia (&gt;3 cm) are exceedingly difficult to treat with antireflux surgery. This report presents the clinical results of patients treated with an emerging technology, the RefluxStop device, in Germany at our two centers.

Method
Between July of 2021 and November of 2023, 158 patients were operated on with RefluxStop surgery. This procedure entails correction of a defunct antireflux barrier through cruroplasty (with hiatal hernia reduction, if necessary), limited (90-120°) esophagogastroplication to recreate the acute angle of His and gastroesophageal flap valve, and regional stabilization of newly constructed anatomy with implantation of the RefluxStop device in a fully invaginated fundic pouch. Clinical outcomes included GERD Health-Related Quality of Life (GERD-HRQL) score, PPI use, and perioperative AEs.

Results
Patients of mean age 49±13.3 years and male (51.3%) had hiatal hernia &gt;3 cm (22.2%). At 20±7-month follow-up, the median (IQR) GERD-HRQL score improved by 90.9% to 2 (0-2) from a baseline of 22 (19-31.5) (p&lt;.001). PPI use decreased by 96.3%. Preoperative dysphagia (n=18) resolved in all patients with five cases (3.2%) of new-onset dysphagia occurring, but none requiring postoperative dilation. Hiatal hernia recurred in two patients (1.3%) and was treated with device repositioning. Device migration presented in two patients (1.3%) from excessively tight suturing of the fundic pouch. One of these patients was converted to Toupet fundoplication.

Conclusion
This study shows that RefluxStop provides excellent effectiveness and safety outcomes. Quality-of-life improvements were particularly appreciated with a 90.9% reduction in GERD-HRQL score. With the added context of 22.2% of this pooled cohort composed of difficult-to-treat patients (i.e., hiatal hernia &gt;3 cm), RefluxStop surgery provides favorable efficacy in real-world settings with such patients. As with any novel surgical procedure, training is paramount to optimizing surgical outcomes and minimizing unwanted AEs. Further study is required to bolster the evidence supporting this emerging technology.
HPB O05 - Changing paradigms in the management of severe acute pancreatitis: Focused multi-disciplinary working between surgeons and intensivists to mitigate organ failure in order to reduce mortality
Authors: Chatzipavli Viktoria , Tzamou Vasiliki , Main Norman , Szatmary Peter , Gilbert-Kawai Ned , Mann Kulbir 
Published: November 2024

Abstract

Background
Mortality was classically bimodal in severe acute pancreatitis and organ failure is the single most important factor in predicting outcome in severe acute pancreatitis. Initial interventions are supportive often requiring critical care. Subsequently treatments are required to manage necrosis and any organ recovery remains under threat. The outcomes and interventions from surgery and critical care are reviewed to determine how to balance organ failure and the need for necrosectomy in a modern multi-disciplinary tertiary care centre

Method
The Royal Liverpool provides a tertiary service to all patients with pancreatitis across Merseyside and North Wales. All patients that were transferred to critical care from 2018 – 2023 were analysed using the intensive care national audit and research centre database which contains information on organ failure. The patients with severe pancreatitis were then reviewed using electronic clinical notes and radiology images to determine clinical course and management.

Results
Of 134 patients, 48 (36%) were admitted locally, 85 (64%) transferred in, occurring 35% &lt;2weeks, 29% 2-4weeks, 28% 4-6weeks and 8% &gt;8weeks. 76 (57%) required necrosis intervention, 58 (43%) were conservatively managed. Mortality was 38% with 35% &lt;4weeks, 22% 4-8weeks, 22% 8-12weeks, 22% &gt;12weeks. No significant difference in mortality between conservative or interventional management (15 (45%) vs 18 (55%)) nor median age (58 vs 57.5 yrs). Survival related to number of failing organs (dead vs alive): nil organs: 10 patients vs 27 patients (20%vs32%), One: 11 vs 45 (22%vs45%), Two: 21 vs 9 (42%vs11%), Three: 8 vs 3 (16%vs4%), p&lt;0.005.

Conclusion
Of patients deemed fit for ITU admission with necrotising pancreatitis, the classic paradigms of biphasic mortality no longer occur. Differences in mortality from intervention and age of patient has been negated by optimal ITU management for organ failure. For the initial phases and the intervention phases of management, ensuring degree of organ failure is key to survival. There is a significant change when two organs fail in mortality and this stresses the importance of holistic management. Our ITU promotes pancreas specific organ preservation measures of early enteral feeding, cessation/tailoring of antibiotics, early extubation/tracheostomy and most importantly multidisciplinary working
MS O01 - HPB Outcomes following Cholecystostomy Insertion for Acute Cholecystitis: A National Registry-based Study
Authors: Billur Aditya , O’Connell Robert M , O’Sullivan A W , Gall Tamara , McEntee Gerald , Conneely John 
Published: November 2024

Abstract

Background
Acute cholecystitis (AC) is a commonly encountered surgical emergency. In cases of severe AC or cholangitis, or in patients with significant comorbidities, percutaneous cholecystostomy (PC) may be employed. International data suggest PC is associated with significantly worse patient outcomes, but limited data exist in the Irish context.

Method
All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics including age, co-morbidities, length of stay/LOS, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. All patients managed with PC were identified, and their outcomes compared to patients managed without PC.

Results
In total, 20,886 patients were admitted with AC. 975 (5%) patients underwent PC and 19,911 patients (95%) were managed without percutaneous cholecystostomy. In comparison to non-cholecystostomy cohort, the PC cohort was older (median 72 v 58 years, p&lt;0.001), less likely to be female (39% v 57% p&lt;0.001), had proportionally longer LOS (&lt;0.001), higher mortality rates (&lt;0.001), were more likely to be admitted to critical care (&lt;0.001), and more likely to be re-admitted to hospital within 30 days (&lt;0.001).

Conclusion
Cholecystostomy insertion occurs in older patients with more comorbidities. These patients have higher in-hospital mortality rates, higher rates of critical care admission, longer LOS, and increased 30-day readmission rates.
MS O03 - HPB Vitamin D deficiency and Survival in Pancreatic Ductal Adenocarcinoma Patients Who Received Adjuvant Chemotherapy
Authors: Leung Shun Hay Prudence , Halle-Smith James , Roberts Keith 
Published: November 2024

Abstract

Background
It is proposed that vitamin D contributes to reducing inflammation and tumour size by binding to vitamin D receptors (VDR) of pancreatic cancer cells, which activates response pathway thus enhancing delivery of intracellular chemotherapy. As vitamin D is a fat-soluble vitamin, individuals with pancreatic ductal adenocarcinoma (PDAC) are at risk of being vitamin D deficient due to the high prevalence of pancreatic exocrine insufficiency (PEI). We investigated the relationship between vitamin D deficiency and survival outcomes of patients with PDAC.

Method
Patients who had resected PDAC at Queen Elizabeth Hospital Birmingham between 2014-2020 were reviewed. Patients who died within 90 days of the operation were excluded. Patient demographics, pre-operative vitamin D levels, adjuvant chemotherapy (AC) details and survival outcomes were collected. Vitamin D deficiency was defined as the serum 25-hydroxyvitamin D (25(OH)D) level of less than 25 nmol/L.

Results
202 patients were identified, of whom 63 (31%) were vitamin D deficient. Among 151 patients who received AC, 48 (32%) were vitamin D deficient. Patient demographics were comparable between the AC and non-AC groups, except age, which was higher in the non-AC group (p&lt;0.01)(Table 1).
OS and DFS were significantly reduced in patients with vitamin D deficiency compared to those with sufficient vitamin D levels (p&lt; 0.05). This trend was also observed in the AC subgroup. However, no significant differences in OS and DFS were found between vitamin D deficient and sufficient patients in the non-AC subgroup (Table 2).

Conclusion
Vitamin D deficiency is associated with lower OS and DFS, particularly in patients receiving adjuvant chemotherapy (AC). The greater survival outcomes observed in the AC group suggests that vitamin D enhances chemotherapy efficacy. Further studies are required to explore the cellular interactions between vitamin D and PDAC.
MS O08 - HPB Biomarkers for risk stratification of Intraductal Papillary Mucinous Neoplasm of the pancreas: A systematic review
Authors: Birch-Ford James , Rowley William , Tarazi Munir , Stott Martyn 
Published: November 2024

Abstract

Background
Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas is the precursor lesion from which pancreatic ductal adenocarcinoma (PDAC) arises in 10% of individuals. IPMNs may be associated with low-grade or high-grade dysplasia or an associated adenocarcinoma. Accurately determining low-risk from high-risk IPMN is crucial for early detection initiatives for PDAC, so treatment can be offered before invasive cancer in high-risk individuals but without causing harm to low-risk individuals. Currently, imaging forms the basis for stratification but this is costly, resource intense and is limited in accuracy. There is a need to develop biomarkers to improve the risk stratification of IPMN.

Method
A systematic review was conducted according to PRISMA-DTA guidelines by screening EMBASE, MEDLINE, CENTRAL and bibliographic reference lists for comparative studies. Studies were excluded if they were based on non-human subjects, not specific to IPMN, or determined IPMN from PDAC rather than low-grade from high-grade dysplasia in IPMN. Data extracted included study design, cohort demographics, specimen type, biomarker type, methodology for biomarker discovery, positive predictive value, negative predictive value, sensitivity, specificity or AUC value and were evaluated against the STARD checklist. Study quality was evaluated using the QUADAS-2 tool.

Results
We identified 1761 studies of which 88 were selected for analysis. Twenty-six studies identified biomarkers derived from serum/plasma, 25 from biopsy specimens, 18 from cystic fluid, 13 from radiological findings, 4 from pancreatic juice, 3 from clinical risk stratification and 1 urinary biomarker. Markers were based on proteins (43%), mRNA (1%), miRNA (14%), lncRNA (2%), DNA (16%), metabolites (1%), radiomics (19%), glycans (5%), inflammatory markers (5%) and clinical history (5%). We observed discriminatory values ranging from AUC 0.58-1, specificity 64-100% and sensitivity 56-90.9%.

Conclusion
This systematic review outlines the current evidence-base for potential biomarkers to determine low-risk from high-risk IPMNs of the pancreas. Current studies are limited by retrospective sample collection, limited cohort sizes and lack of external validation of candidate biomarkers. There is a need to develop and validate biomarkers in a longitudinal prospective cohort study of individuals undergoing IPMN screening with the ability to characterise low-risk to high-risk transformation which after external validation would be suitable for adoption into clinical practice.
MS O11 - HPB Laparoscopic vs open liver resections for hepatocellular cancer in a tertiary care hepatobiliary unit; outcomes of cases over 10 years
Authors: Sherratt-Mayhew Sam , Page Charles , Rehman Saad , Shah Tahir , Shetty Shishir , Papamichail Michail , Raza Syed Soulat , Roberts Keith , Chatzizacharias Nikolaos , Bartlett David , Marudanayagam Ravi , Sutcliffe Robert , Dasari Bobby V M 
Published: November 2024

Abstract

Background
Despite its established role in liver resection surgery, minimally invasive surgery is still not a favoured option in cases of hepatocellular cancer (HCC) due to perceived risks of intra- and post-operative surgical morbidity and poorer oncological outcomes. This study aims to look at the outcomes of liver resections performed for HCC cases over ten years comparing laparoscopic and open cohorts.

Method
A retrospective study including all liver resections for HCC cases performed in our tertiary care hepatobiliary unit between 2013 and 2022 (10 years) was conducted. Data on demographics, underlying degree of liver cirrhosis, types of liver resection and post-operative outcomes, including recurrence rates and resections margins were collected and reported using descriptive statistics. Survival analysis was performed with compared between these two groups with log rank test in GraphPad prism 10.

Results
200 liver resections performed for HCC were grouped into laparoscopic and open cohorts containing 147 and 53 patients respectively. 21 (40%) laparoscopic cases had background liver cirrhosis as compared to 24 (16%) in open cases. Major liver resection comprised 9% and 43% of all cases and one and five patients had Grade B/C PHLF in laparoscopic and open groups. All 8 (4%) cases with 90-day mortality were from the open group. Negative resection margins (68% vs 71%), local recurrence (51% vs 47%) and overall survival (75 months vs 67 months (p=0.29)) were similar in laparoscopic and open groups, respectively.

Conclusion
Post-operative and oncological outcomes of liver resections for HCC were comparable in laparoscopic and open groups. Laparoscopic liver resections could be safely performed in patients with background liver cirrhosis.
MS O12 - HPB The efficacy of CA19-9 in predicting resectability and survival in pancreatic cancer patients with jaundice: A retrospective cohort study
Authors: Keyte Imogen , Turner Jessica , Halle-Smith James , Roberts Keith 
Published: November 2024

Abstract

Background
Carbohydrate antigen 19-9 (CA19-9) is the most utilised biochemical marker in pancreatic ductal adenocarcinoma (PDAC); shown to be related to resectability and prognosis. However, concurrent cholestasis, commonly seen in PDAC, can also elevate CA19-9, which may lead to unreliability and hence limit its efficacy in jaundiced patients, making management planning and prognostication more challenging. This study aims to investigate the impact of jaundice on the efficacy of CA19-9 in predicting resectability and survival in PDAC patients.

Method
715 patients undergoing attempted resection for PDAC between 2010-2023 were identified from a prospectively maintained surgical database for retrospective analysis. The ability of CA19-9 to predict resectability and survival in different bilirubin sub-groups was assessed using receiver operating characteristic and Kaplan-Meier curves. Existing adjustment methodologies were applied and the curves replotted to assess their effects on the predictive efficacy of CA19-9. Multivariate analysis was then utilised to screen other potentially predictive factors which could be incorporated in the future.

Results
Of the 554 (77.4%) patients who underwent resection, CA19-9 predicted resectability in the first three bilirubin subgroups: ≤21 µmol/l (AUROC:0.660, 95% CI:0.551-0.769, p=0.004), 21&lt;x≤130 µmol/l (AUROC:0.689, 95% CI:0.595-0.784, p&lt;0.001) and 130&lt;x≤315 µmol/l (AUROC:0.710, 95% CI:0.614-0.807, p&lt;0.001). However, CA19-9 did not predict resectability in patients with bilirubin levels &gt;315 µmol/l (AUROC:0.579, 95% CI:0.452-0.707, p=0.222). CA19-9 was a significant predictor of overall survival in the non-jaundiced (p=0.048) cohort but did not predict survival in patients with bilirubin levels &gt;21 µmol/l. Existing adjustment methodologies did not improve predictive efficacy of CA19-9 for resectability or prognosis.

Conclusion
These findings support the prospect of decreased ability of CA19-9 to predict resectability and survival in PDAC patients with jaundice. Further investigation is required to find a method of adjusting CA19-9 values based on jaundice to aid diagnostic and treatment decision making.
VS 01 - BN Chronic loop gastrojejunostomy volvulus masquerading as a Crohn’s stricture
Authors: Loh Alex Yuen Hua , Tase Arkeliana , Karim Seiver , Al-Fagih Othman , Jambulingam Periyathambi 
Published: November 2024

Abstract

Background
A video presentation of a case of chronic loop gastrojejunostomy volvulus masquerading as a Crohn's stricture.

Method
61 year old female with a previous loop gastrojejunostomy and subsequent ileocaecal resection for Crohn's related pyloric stenosis and terminal ileal stricture. Acute worsening of post-prandial pain and vomiting 5 years later, re-investigation revealed a stenosed gastrojejunostomy thought to be Crohn's related.

Results
Intraoperative volvulus of the gastrojejunostomy was demonstrated related to traction forces resulting in the migration of the duodeno-jejunal flexure to the right of midline. The gastrojejunostomy was revised to a Roux-en-Y configuration with relief of mechanical obstruction.

Conclusion
An ileocaecal resection may create unexpected traction forces
VS 03 - BN Laparoscopic Excision of Aortic Schwannoma
Authors: Shehata Zak , Satyadas Thomas 
Published: November 2024

Abstract

Background
This video presentation describes a laparoscopic approach to the excision of a large retroperitoneal cyst in a 39 year old female presenting with generalised abdominal pain. The patient had a background of Type 2 Diabetes, as well as a laparoscopic hysterectomy.

Method
The patient presented acutely with the above symptoms. CT and MRI both confirmed a large retroperitoneal cyst measuring 8x9cm. EUS was performed showed a thin walled cyst and a normal pancreas. FNA cytology was benign, hydatid serology was negative

Results
MDT decision was to go ahead with formal surgical resection. Laparoscopic excision of the cyst was performed, demonstrating that the pancreas was displaced anteriorly, with the coeliac axis displaced to the right. The cyst did not involve the pancreas or adrenal gland. Post operative histology found the cyst to be an aortic schwannoma.

Conclusion
This video demonstrates the complex retroperitoneal dissection that can be performed laparoscopically. The patient was discharged on post op day 8 with surveillance follow up
VS 10 - HPB Pancreas preserving total duodenectomy, How I do it
Authors: Hammoda Mohammed , Al-Sarireh Bilal 
Published: November 2024

Abstract

Background
Patients with duodenal polyps particularly patients with familial adenomatous polyposis syndrome (FAP) are at increased risk of developing duodenal cancer. Pancreas preserving total duodenectomy is an alternative to pancreaticoduodenectomy. Advantages over pancreaticoduodenectomy include: shorter operative time, fewer and safer anastomoses, allowing future endoscopic surveillance and preserving the entire pancreas with both exocrine and endocrine functions. The complication rate is comparable if not fewer than pancreaticoduodenectomy. Here, we present our standardised operative technique for this procedure.

Method
This a video presentation of the technique of this novel procedure. The video has been edited with added narrative comments on the different steps of the procedure.

Results
This is a video presentation of the technique of pancreas preserving total duodenectomy in a patient with familial adenomatous polyposis syndrome to treat Spiegelman IV duodenal polyps.

Conclusion
The PPTD provides a feasible and probably favourable if not better alternative to classical pancreaticoduodenectomy particularly in patients with FAP syndrome.