bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB SO41 - Does Adjuvant Chemotherapy Provide a Survival Benefit in Elderly Patients (≥70 years) with Pancreatic Cancer? A Retrospective Cohort-study
Authors: Solomon Rosie , Patel Agastya , Kitching Samuel , Barker Sharon , Lancellotti Francesco , Kadamapuzha Jacob , Satyadas Thomas 
Published: November 2024

Abstract

Background
There is currently conflicting evidence surrounding the use of adjuvant chemotherapy (AC) for elderly patients (over 70 years) with pancreatic adenocarcinoma. Limited existing studies debate its effect on overall survival (OS) and relapse-free survival (RFS). The aim of this study is to assess whether adjuvant chemotherapy following pancreaticoduodenectomy provides a survival benefit in elderly patients with pancreatic cancer.

Method
A retrospective review including elderly adult patients, seventy years and older, who underwent a Whipple’s pancreatoduodenectomy for pancreatic adenocarcinoma between 1st January 2015 and 31st December 2020, at a tertiary HPB centre was performed. Information on baseline characteristics, preoperative assessment, histopathology, postoperative complications and course, and adjuvant chemotherapy were collected. Elderly patients who received AC were compared to those who did not undergo AC. Statistical analysis was performed using Jamovi 2.3.

Results
Sixty-eight patients were included with 44 (65%) receiving AC. There was no difference in age (p=0.72), sex (p=0.19), preoperative characteristics (all p&lt;0.05), and resection margin (p=0.67) between the groups. There was no difference in complication rates (p=0.20), including Clavien-Dindo3+ (p=0.68). The length of hospital stay was shorter in the AC group, without statistical significance (15.7±11.9 vs 23.2±20.3 days, p=0.06). There was no difference in RFS between the groups (22.7±20 vs 15.4±23.6 months, p=0.18). However, patients who received AC had a significantly greater OS compared to those who did not (30.7±18.2 vs 18.6±22.2 months, p=0.02).

Conclusion
AC improved overall survival in elderly (≥70 years) patients with pancreatic adenocarcinoma. Whilst many elderly patients may not receive adjuvant chemotherapy due to postoperative complications and/or longer hospital stay, our study suggests age alone should not be a deciding factor when considering adjuvant chemotherapy in this cohort. A future large, multicentre prospective study is needed to further examine OS with the use of AC in elderly patients with pancreatic adenocarcinoma.
HPB SO47 - Adjuvant chemotherapy for early pancreatic cancer: Meta-analysis of survival benefit and the need for a national study of UK practice
Authors: Athwal Tejinderjit , Evans Daisy 
Published: November 2024

Abstract

Background
Stage I pancreatic cancer is defined as disease localised to the pancreas (T1-T2, N0, M0). Whilst landmark trials have demonstrated adjuvant chemotherapy (AC) improves survival in resectable disease, early stages comprise only 3-8% of cases. The benefit of AC in stage 1 pancreatic cancer is yet to be defined and there currently exists no data outlining the use of AC for early disease in the United Kingdom (UK). We aimed to perform a meta-analysis evaluating comparative outcomes of pancreatic cancer resection with or without AC in patients with stage I pancreatic cancer and outline plans for a national collaborative study.

Method
A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies reporting outcomes of pancreatic cancer resection for stage I cancer with or without AC were included and their risk of bias were assessed using ROBINS-I tool. Survival outcomes were analysed using hazard ratio (HR) and odds ratio (OR) for the time-to-event and dichotomous outcomes, respectively.

Results
We included six studies reporting 6,874 patients with resected stage 1 pancreatic cancer of whom 3,951 patients had no AC and the remaining 2,923 patients received AC. The use of AC was associated with significantly higher overall survival (HR 0.71, P&lt;0.00001) and 2-year survival (65.1% versus 57.4%, OR 1.99, P=0.04) compared to no use of AC. There was no statistically significant difference in 1-year (86.8% versus 78.4%, OR 1.60, P =0.25), 3-year (46.0% versus 44.0%, OR 1.07; P =0.43), or 5-year survival (24.8% versus 23.3%, OR 1.03; P =0.81) between the two groups.

Conclusion
Meta-analysis of best available evidence (level 2a with low to moderate certainty) demonstrates that AC may confer survival benefits for stage I pancreatic cancer when compared to the use of surgery alone. National evaluation of the use of AC within the UK is currently lacking but is necessary. Randomized control trials are required to escalate the level of evidence and confirm these findings with consideration of contemporary chemotherapy agents and regimens.
HPB SO48 - Evaluating the timeframe for the provision of laparoscopic cholecystectomy in acute cholecystitis patients at a regional hospital
Authors: Tan Hao Ming , Tan Jia Xuan , Aleem Khalid Atta U L , Hemadri Makani 
Published: November 2024

Abstract

Background
Acute biliary disease comprised a substantial proportion of the general emergency surgical workload. AUGIS and NICE guidelines recommend early laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) patients as it is associated with reduced readmission rates, healthcare costs and faster recovery without notable complication risks. According to the local trust policy, it advocates early LC to be performed within 72 hours of admission for AC patients. If this is not possible a delayed LC should be performed within 8 weeks of admission. Our aim is to examine variations in the provision of LC between current practice and local trust/ NICE guidelines.

Method
This is a retrospective audit looking at the total number of surgical patients diagnosed with AC between Jan and Dec 2023. The number of patients who had LC in 2023, unfit for surgery and did not consent for the procedure were also included. This data was obtained from electronic patient records (investigative reports, discharge letters, outpatient letters) and then collated on a Microsoft Excel sheet for analysis. Surgical patients who were not diagnosed with AC such as those with biliary pancreatitis, cholelithiasis or cholangitis but subsequently underwent LC were excluded.

Results
The number of AC patients who were fit and consented to surgical intervention in 2023 was 88. The total number of delayed procedures done was 75 (85.2%). The number of patients who had early LC within 1 week was 13 (14.8%).
Of the 75 patients who had delayed LC, 19 (25.3%) patients had delayed LC within 8 weeks from the diagnosis date. The remaining 56 (74.7%) patients had delayed LC after 8 weeks.
For patients who had delayed LC, the readmission rate within 6 months of their discharge while waiting for their operative dates was 29 (38.7%).

Conclusion
One-third of AC patients were readmitted while waiting for LC, some had complications of gallstone disease such as perforation/ gallstone ileus. Therefore, the early provision of LC is crucial in minimising the readmission and complication rates. This data was highlighted in a departmental meeting and teaching session for consultants and junior doctors. We plan to liaise with stakeholders and theatre managers in implementing further solutions to improve compliance where possible. One critical area is auditing the condition of surgical patients in order to be put on the hospital’s twice-weekly hot gallbladder list to consider prioritising AC patient surgical time.
HPB SO54 - Outcomes of Isolated Bile Duct Resection for Cholangiocarcinoma; More Than 15 Years Experience in a Single Tertiary HPB Centre
Authors: Alnagar Amr , Ayoub Rami , Sutcliffe Robert , Marudanayagam Ravi , Keith Robert , Chatzizacharias Nikolaos , Dasari Bobby , Raza Syed , Bartlett David 
Published: November 2024

Abstract

Background
Cholangiocarcinoma of the extrahepatic biliary tree usually requires a major resection to achieve clear margins with adequate lymphadenectomy. For perihilar tumours this involves extended liver resection with bile duct resection whilst distal tumours require pancreaticoduodenectomy. Occasionally a combination of both (hepato-pancreaticoduodenectomy) is required. These procedures are associated with high morbidity and mortality. In a small number of patients, cholangiocarcinoma is confined to the extrahepatic bile duct with no involvement of the liver or pancreas and a bile duct resection alone is an option. We reviewed the outcomes of patients who underwent bile duct resection for cholangiocarcinoma in our unit.

Method
We identified all patients who underwent bile duct resection and hepaticojejunostomy for cholangiocarcinoma between June 2007 and June 2023 in our centre from a prospectively maintained database. Patient demographics, complications, histology, resection margin status, follow-up, recurrence, and survival were recorded. Time to recurrence and overall survival were analysed using Kaplan Meier analysis.

Results
Thirteen patients underwent bile duct resection and hepaticojejunostomy for cholangiocarcinoma. 12 (92%) were male and the median (range) age was 72 (41-82). No patients received neoadjuvant treatment. 3 (23%) patients developed postoperative complications with 1 (7.7%) perioperative mortality. R0 margin was achieved in 6 (46%). The median (range) postoperative stay was 7 (5-25) days. 8 (61.5%) patients received adjuvant chemotherapy. 7 patients (53.8%) developed recurrent disease at a median of 12 (IQR 8-54) months following surgery. The most common sites of recurrence were the liver (23.1%) followed by local recurrence (15.4%). The median survival was 38 (IQR 20-95) months.

Conclusion
Extrahepatic bile duct resection with hepaticojejunostomy is an option for patients with cholangiocarcinoma of the extrahepatic bile duct without macroscopic involvement of the liver or pancreas. In our series this procedure was associated with a low morbidity and perioperative mortality with acceptable recurrence rates and overall survival despite only modest R0 resection rates. Isolated bile duct resection with hepaticojejunostomy should be considered for tumours without macroscopic involvement of the liver or pancreas, especially in patients of borderline fitness for a more extensive resection.
HPB SO56 - Prompt prescription of fluids and analgesia for acute pancreatitis and evaluation of subsequent laparoscopic cholecystectomy: A Quality Improvement Project
Authors: Cheong Jeremy , Lee Shiela , Jha Madan 
Published: November 2024

Abstract

Background
Pancreatitis is a common presentation for General Surgery department nationally. Treatment of these patients are timely initiation of analgesia and fluid resuscitation. Patients with gallstone pancreatitis should have inpatient cholecystectomy as per the NICE Guidance. Delays in treatment of acute pancreatitis can worsen mortality and morbidity rates. We aim to assess if patients have been given fluid, analgesia, VTE prophylaxis promptly upon admission and if they had laparoscopic cholecystectomy in the index admission for those with gallstone pancreatitis.

Method
Single centre retrospective cohort of patients, above 18 years old, who presented to general surgery services from November 2022-23. Patients need to have radiological evidence of pancreatitis or raised amylase above 150. Patients were evaluated for prompt prescription of analgesia, fluids and VTE prophylaxis within 24 hours based on our ePrescription system. Evaluation of laparoscopic cholecystectomy service was also performed to assess if patients had the surgery during the indexed admission or within 30 days of discharge.

Results
99 patients with median age of 60 was included. Only 3 patients required higher levels of care in HDU or ITU. The median length of stay was 5 days. 96% had analgesia prescribed, 91% had VTE prescribed but only 81% had fluids. Of those who did not have fluids within 24 hours, the average lenght of stay was 5.5 days and only 1 patient needed to be admitted to intensive care unit. 26 patients had gallstone pancreatitis but 15% had laparoscopic cholecystectomy performed. Our readmission rate was 6% and 30-day mortality was 1%.

Conclusion
Delays in the prescription of fluids and analgesia are still present, with a proportion of patients not getting the appropriate treatment for acute pancreatitis. We will use a tailored prescription set for acute pancreatitis to ensure prompt prescriptions are done for patients. This will be re-evaluated to assess its effectiveness. Further evaluation is required to look at reasons for patients not getting cholecystectomy promptly after admission for acute pancreatitis.
HPB SO57 - Imaging in Acute Pancreatitis: Are We Getting It Right?
Authors: Pal Shreya , Oxenham Matthew , Allu Veera 
Published: November 2024

Abstract

Background
Guidelines indicate that routine use of imaging is unwarranted in patients with acute uncomplicated pancreatitis presenting with abdominal pain and increased serum amylase or lipase levels without signs of severe disease. Moreover, early CT scans may fail to accurately reflect disease severity and provide no diagnostic advantage.

Method
We performed a retrospective clinical audit at a district general hospital in the United Kingdom to find out the current practice regarding the use of imaging in patients presenting with acute pancreatitis. The patients were studied from January 2023 to March 2023 for the 1st cycle, and from April 2024 to May 2024 for the 2nd cycle. The list was identified by the clinical audit department – adult patients who presented to the A&E with symptoms of acute pancreatitis were included.

Results
Between January - March 2023, 44 patients presented to A&E with symptoms of acute pancreatitis. Of these, 25 (56%) had a CT-scan within 72-hours, with 80% showing evidence of acute pancreatitis —1 with pancreatic necrosis, 7 with intra-peritoneal fluid, & 5 with peri-pancreatic fat-stranding. The study revealed poor compliance with standards, prompting efforts to raise awareness. Findings were shared at the departmental audit meeting, & posters were displayed in A&E and GeneralSurgery departments. In the 2nd-cycle (April-May 2024), 32 patients presented, with 14 (53%) having a CT-scan within 72-hours & all had serum amylase levels checked, with 11 within normal limits.

Conclusion
This closed-loop clinical audit demonstrated that with appropriate measures and improved awareness of current guidelines, there can be increased compliance to the guidelines by the clinicians. This, in turn, reduces the risk of radiation exposure to patients and optimizes the use of CT scans.
HPB SO61 - Benefits of Dual-surgeon On-call team on Emergency Laparoscopic Cholecystectomy – a Single Centre Experience
Authors: Moscalu Andrei , Joshi Dipti , Jerin Sabu , Kathayat Lok , Nasef Hazem , Atkari Bence , Liao Christopher 
Published: November 2024

Abstract

Background
Since 2015, UK national guidance from National Institute for Health and Care Excellence (NICE) has been to offer laparoscopic cholecystectomy for patients presenting with acute cholecystitis within 7 days of admission. The aim of this study was to measure the benefits of a second team of surgeons doing emergency operations (first team dealt with emergency admissions and referrals) in terms of length of stay, conversion to open, morbidity, mortality, bile duct injury and rate of early cholecystectomy in a UK based district general hospital.

Method
Retrospective analysis of a prospectively maintained database was collected from electronic health records, admission and operative notes. Results were extracted in terms of index laparoscopic cholecystectomy, rate of conversion, intra-operative cholangiography, associated morbidity, mortality, bile duct injury, conversion to open, readmission rate and length of stay. The numbers and rates of cholecystectomy over the last six years duration was collected and compared year-on-year period, since early 2019 after the implementation of dual-surgeon on-call cover.

Results
Altogether, there was 944 cholecystectomy performed within 14 days, out of which 74% of cases was operated within the first week of presentation &lt;8 days since admission. Majority of cholecystectomy was performed laparoscopically, there were twenty-three (2.43%) conversion to open, forty-six sub-total cholecystectomies (4.87%),intraoperative cholangiography was performed in 28.4% of cases and Indocyanine green (ICG) cholangiography was used in 50.5% of all cases. Average length-of-stay (LOS) was 2.2 days, there were eight cases (0.84%) of post-op bile leak, one bile-duct injury, one case of post-operative bleed, one case of small bowel injury and two deaths.

Conclusion
With the adoption of dual-surgeon on call, early laparoscopic cholecystectomy benefits both patient and hospital. It reduces time to surgery for patients, decreases overall length of stay, and reduces readmission rates and cost, with similar morbidity and mortality.
HPB SO62 - Association of positive bile cultures and the incidence of pancreatic fistulas post pancreaticoduodenectomy[PD]
Authors: Atluri Lakshmi Malvika , Chong Kenneth , Subar Daren 
Published: November 2024

Abstract

Background
Postoperative pancreatic fistula (POPF) remains a significant complication post pancreaticoduodenectomy (PD). Recent publications show no increased incidence of POPF due to positive bile cultures. A literature search on PubMed did not show any review on the relevance of specific cultures and their exact incidence of POPF.
POPF is defined as Drain Amylase greater than three times its serum level on or after postoperative day 3. A relatively benign clinical course is grade A, moderately unwell patients requiring medical/minimal intervention (grade B), and critically ill patients with sepsis, requiring invasive intervention (grade C). Grade B + C is defined as CR-POPF.

Method
A retrospective single-centre analysis of all patients with pancreaticoduodenectomy between 2017 and 2021 was reviewed. The clinical data that were reviewed were age, gender, length of stay[LOS], tumour staging, mortality rates, Pancreatic duct[PD], Pre-op stenting, the documented incidence of POPF/CR-POPF, Intra-Operative Bile Cultures[IOBC] and antibiotic sensitivity.
The primary outcome was POPF. Secondary outcomes were 90-day mortality, LOS, return to theatre, Postoperative haemorrhage (POPH), and organ-specific relevance of POPF. All data was analysed using SPSS IBM version 29. P&lt; 0.05 was taken as clinically significant.

Results
100 patients were included in the study. The mean age was 68.8 (SD-9.5). The M: F ratio was 54:46. The mean postoperative length of hospital stay was 19.38 days. 48 patients (48%) were diagnosed with a POPF, among which, 22 patients (47.8%) developed a CR-POPF. 57 patients had a positive IOBC. The incidence of POPF in patients with Positive IOBC was 43/57(75.43%) and that was 5/43(11.62%) of the patients with Negative IOBC (P &lt; .0001).10% of patients had postoperative haemorrhage (POPH). 9% had 90-day mortality. All 9% of patients who had a return to theatre had POPF.

Conclusion
Univariate analysis and logistic regression demonstrated that a positive IOBC had a higher associated incidence of POPF who underwent PD, with Klebsiella being the most common and statistically significant[P&lt;.005]. The most common antibiotic found to be sensitive was Gentamicin, which is 25 per cent and, in combination with Co-amoxiclav, was found to be sensitive in 21.8% of cases. However, this is a single-centre retrospective study with variable operative techniques for different patient groups. Further studies would be warranted before correlating any results to all populations of patients developing POPF post pancreaticoduodenectomy.
HPB SO65 - An audit of the day-case rate of laparoscopic cholecystectomies at a busy district general hospital and factors affecting this
Authors: Stobiecka Roksana , Dunstan Matthew , Thomas Rhys 
Published: November 2024

Abstract

Background
The target day case rate of laparoscopic cholecystectomies at a busy district general hospital is 75%, as per Model Hospital Guidelines. The current rate at which day cases are achieved is 55%. This audit aims to identify factors relating to the DGH not reaching their day case target and explore potential solutions for these, with the intention to reduce patient’s hospital stay and, therefore, overall costs.

Method
119 patients had undergone a laparoscopic cholecystectomy in the first five months of 2024. Exclusion criteria included hot cholecystectomies, common bile duct explorations and planned admissions. The remaining 85 patients were included in this audit. The data proforma included age, ASA, BMI, co-morbidities, Nassar grade, scheduled and actual time of operation and any reasons for delay.

Results
Of the 85 patients included in this audit, 34% (29) were not daycases. 11 remained an inpatient due to post-operative nausea or pain, 3 due to requiring an MRCP, 9 were kept in for monitoring, 2 had intraoperative bleeding, 3 had social issues and 1 required IV antibiotics. 58% of the 29 had afternoon operations. 48% of the 29 had a Nassar grade of greater than 1. 38% of the 29 had a BMI greater than 30.

Conclusion
Various reasons for a case to not achieve daycase status were found, with the most common being post-operative pain or nausea. It would prove beneficial to educate patients on common post-operative symptoms and focus on managing these symptoms effectively. Pre-operative appointments should aim to explore a patients home setting at the time of the operation and ensure to book inpatient stays for those who require it, in advance. Theatre lists should be optimised by giving high-risk patients morning slots.