bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS SO33 - Management Strategies and Outcomes of Non-Malignant Oesophageal Perforation at a Tertiary Care Hospital
Authors: Bhatti Khalid , Laulloo Sufia , Subramaniam Sheena , Lilley Jaiesh , Ward Jeremy , Pursnani Kish , Turner Paul , Sarantitis Ioannis , Nandi Sumit , Ball Christopher , Shetty Vinutha Daya 
Published: November 2024

Abstract

Background
Oesophageal perforation is a life-threatening emergency that requires prompt and effective management. This study aims to evaluate the outcomes of different management strategies—conservative, surgical, and endoscopic washout with stent insertion—for non-malignant oesophageal perforations at a specialist Upper GI unit in a tertiary care hospital.

Method
This is a retrospective study conducted over a 10-year period from 2012 at a specialist Upper GI Unit in a tertiary care hospital. All patients aged 18 and above who were referred to or admitted with oesophageal perforation were included, with exclusion of those with underlying oesophageal cancer. Data were collected from hospital records. Variables studied included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, site and size of oesophageal perforation, treatment modality (Conservative, Surgery, or Stent), type and size of stent used, length of hospital stay, and mortality. Data analysis was performed using SPSS v.25.

Results
Over 10 years, 72 cases of non-malignant oesophageal perforation were managed (M:F, 37:35, median age 62.5 years (range 20-86), median CCI 3). The causes of perforation were spontaneous (n=45, 62.5%), iatrogenic (n=22,30.6%), foreign body (n=4,5.6%), and post-corrosive intake (n=1,1.4%). Most perforations occurred in the distal oesophagus (n=52, 72.2%) with an average size of perforation of 3 ± 1.38cm. Management included surgery (n=43,59.7%), conservative treatment (n=22,30.6%), and stent insertion (n=7,9.7%). Overall, in-hospital mortality was 20.8% (n=15). Survival rates varied: 90.9% for conservative treatment, 79.1% for surgical management, and 57.1% for stenting; however, the differences were not statistically significant (p=0.134).

Conclusion
Oesophageal perforation is a life-threatening condition. This 10-year observational study assessing conservative, surgical, and stent treatments for non-malignant perforations confirms that survival rates varied among the different treatment groups. However, there was no statistically significant survival advantage observed. This underscores the importance of developing individualized management plans based on patient factors to improve outcomes.
OGC SO02 - Analysis of routine upper gastrointestinal endoscopy referrals and outcomes in a single tertiary service
Authors: Lawton Aimee , McElvaney Joseph , Glen Paul 
Published: November 2024

Abstract

Background
Routine (category 3/4) upper gastrointestinal endoscopies (UGIE) constitute a significant proportion of endoscopy workload in the National Health Service. Referrals are varied and there are opportunities for service improvement to reduce clinician burden and improve patient outcomes. This is of particular relevance to the early detection and prevention of cancer.
This work aimed to analyse routine UGIE referrals and subsequent endoscopies in a large tertiary service to identify quality improvement opportunities within the health board.

Method
Referral indications for all males over 50 years awaiting routine UGIE in the health board on 02/03/2023 were reviewed. Referrals were categorised into 7 groups based on primary presentation and indication for UGIE; “Liver/variceal”, “Gastric”, “Oesophageal”, “Anaemia”, “Dysphagia”, “Tissue transglutaminase (TTG) positive” or “Other”. Data on findings, biopsy, and follow-up were gathered where UGIE was subsequently performed. To analyse routine cases only, patients referred for anaemia or dysphagia were excluded from final analysis.

Results
471 records were reviewed and 332 patients included in final analysis; 210 had undergone UGIE at assessment point (3 records unavailable), with 99 waiting and 23 died/did not attend/declined. The most common referral indications were “Gastric” (41.6%), “Liver” (29.2%), and “Oesophageal” (21.4%) (n=207). 84 were excluded due to anaemia/dysphagia.
At UGIE, 6.3% identified Barrett's oesophagus/malignancy across all groups with 1 case of new malignancy. 80.2% received medical/conservative management following their scope.

Conclusion
While pathology was identified at routine UGIE, a large number of procedures were required to identify this and there was no Barrett's oesophagus rich group. We have identified opportunities for improvement in the delivery of routine UGIE service in the health board which may reflect nationally. These include altered vetting practices and potential UGIE-saving procedures including cytosponge.
OGC SO10 - Modification of the Complications Parameter for ‘Textbook Outcome’ in Oesophageal Cancer Surgery
Authors: Vardon Henry , Brown Leo , McGregor Richard 
Published: November 2024

Abstract

Background
Surgical resection is cornerstone of curative treatment for most patients with oesophageal cancer. ‘Textbook outcome’ (TBO), a composite outcome measure, was proposed to benchmark quality of care for patients undergoing oesophagogastric cancer surgery. One required parameter for TBO is the absence of ‘severe’ complications (defined as Clavien-Dindo (CD) grade ≥2). In recent years there has been debate regarding whether a CD grade 2 complication should be considered a significant deviation from the desired post-operative course. This study aimed to assess whether revised a TBO parameter of CD≥3 is associated with improved overall survival in patients undergoing oesophagectomy for cancer.

Method
Data were collected for consecutive patients who underwent oesophagectomy for cancer at a single tertiary centre in the United Kingdom, between January 2018 and February 2020. Patients were identified from a prospectively maintained regional database with additional datapoints sought from electronic patient records. These included baseline clinicopathological characteristics, treatment details and the previously defined postoperative outcomes required for assessment of TBO. The primary outcome of interest was overall survival.

Results
Ninety-one patients (68.1% male, median 67 years (IQR: 59-72)) underwent oesophagectomy. Most had clinical stage III (61.5%) or IVA disease (28.6%) and underwent neoadjuvant chemotherapy (82.4%). When classified using the CD≥2 parameter, 15.4% achieved TBO compared with 41.8% when using CD≥3. Improved overall survival was observed in patients with a TBO using CD≥3 complication parameter (p=0.033). Survival was comparable between TBO and non-TBO group with the CD≥2 cut-off (p=0.550). TBO using CD≥3 remained associated with better survival, following adjustment for confounding variables, (HR:0.50 (95%CI:0.26-0.97), p=0.042)) while TBO using CD≥2 was not (HR:0.81 (95%CI:0.33-2.00, p=0.648)).

Conclusion
This study demonstrates that an association between TBO and overall survival in our patient population was only evident when the parameter requiring no ‘severe complication’ was re-defined as CD≥3. Consideration of TBO for specialist units may be useful for benchmarking quality and for prognostication.
OGC SO16 - International upper GI robotic fellowship on the CMR Versius platform
Authors: De Rosa Antonella , Alqudah Abdallah , Mitchell Benjamin , Lasheen Omar , Cotton Arthur , Dwerryhouse Simon , Upchurch Emma , Hornby Steve , Vipond Mark , Higgs Simon 
Published: November 2024

Abstract

Background
The impetus for UGI surgery trainees to attain skills in robotic surgery is likely to increase following the global acceptance and utilisation of robotic platforms. UGI robotic fellowship programs are few in number and highly desirable providing trainees with a unique selling point when embarking on independent consultant practice. We describe the first UGI robotic surgery fellowship on the CMR Versius platform at the Gloucestershire Royal Hospital which has the largest experience of UGI robotic surgery on the CMR Versius platform in the UK, having performed over 200 cases including the first robot assisted minimally invasive oesophagectomy.

Method
A structured robotic training curriculum was created in collaboration with CMR Versius. It consists of a pre-clinical phase of E-learning (10 modules), simulator training (16 assessed tasks) and dry-laboratory training (a two-day course encompassing robotic system set-up, bed-side assist and assessed dry lab practical tasks). The clinical phase begins with bed-side assisting of robotic cases followed by supervised operating on the console. Operations performed on the console are recorded for review and evaluation. The videos will be scored by two independent surgeons using the modified Global Evaluation Assessment of Robotic Skills (mGEARS) score to track growth and progress.

Results
The E-learning modules and assessments were completed prior to commencement of the fellowship. The remainder of the pre-clinical phase of the curriculum were completed within 4 weeks of commencement followed by bed-side assisting. Once competent at bed-side assisting and able to demonstrate proficiency in set-up (selecting port site placement, docking, arm spacing and configuration), supervised console training was commenced 6 weeks into the fellowship. Console training began with robotic assisted laparoscopic assisted cholecystectomy to gain familiarity, confidence, and efficiency. After 6 cases as the only console surgeon, the surgical complexity of cases was progressed to hiatal surgery and Heller’s cardiomyotomy

Conclusion
A structured training curriculum with defined phases provides a feasible and effective framework for robotic fellowship training. Adherence to the pre-clinical phase of training allows safe and efficient progression to hands-on console experience. This is achievable within relatively short timeframe to allow for ample independent console surgeon experience and the development of proficiency within a 12-month fellowship period.
OGC SO19 - Management and outcomes for Barrett’s oesophagus with dysplasia in a tertiary centre
Authors: Longbotham David , Kane Jack , Khiyar Yassir , Mitton David , Jain Prashant 
Published: November 2024

Abstract

Background
Barrett’s oesophagus is a premalignant condition. Development of high-grade dysplasia (HGD) formerly was an indication for oesophagectomy, but endoscopic treatment (ET) is now recommended as first-line therapy: radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR). Oesophagectomy is only considered for cases where ET was unsuccessful.
Previous review of our institution’s outcomes between 2014 and 2017 showed a 54% complete EMR excision rate and 20% salvage oesophagectomy (n=25). Since then, RFA has been utilised in our institution. We aimed to review our recent data to assess current outcomes.

Method
Retrospective analysis was performed of patients identified via registration at the Hull University Hospital Trust oesophagogastric MDT between March 2017 and December 2023. Inclusion criteria was confirmed histology of HGD on 2 occasions by 2 specialist pathologists, 6 weeks apart. EMR was performed for focal oesophageal lesions and non-nodular segments were treated by RFA. Patients were included once they had at least one surveillance endoscopy and 6 months had passed following treatment.
Patients who were either unfit for ET and managed medically (n=6), and those who were subsequently proven to have more advanced disease and treated surgically (n=4) were excluded.

Results
35 patients were identified: 20 underwent EMR, 15 RFA.
55% of EMR patients had successful excision, 9 required additional RFA for residual low-grade dysplasia (LGD). 66% RFA patients had successful ablation. 3 patients required further EMR for residual LGD. Overall 82% had successful ET with no HGD on surveillance. 5 patients had persistent HGD and 1 T1b disease: 4 underwent oesophagectomy, 2 managed oncologically.
Barrett’s tended towards being longer in patients where ET failed to eradicate HGD (median 6cm vs 3cm MWU p=0.07).
No patient in the series died because of disease-related pathology. 1 patient developed stricture post-RFA requiring dilatation.

Conclusion
ET for HGD is effective with a high rate of successful treatment. It can be used as a single or dual modality. Salvage oesophagectomy rates are lower than previously reported (8% vs 20%) and complications are low (3% stricture rate). Longer segment Barrett’s may be less likely be responsive to ET, although not reaching significance in our series. ET should continue to be offered as the first-line treatment for oesophageal HGD.
OGC SO22 - Accuracy of CT and FDG/PET clinical staging within a dedicated multidisciplinary service for patients with oesophago-gastric cancer
Authors: North Samuel , Tokhi Ashraf , Reid Eleanor , Clarke Simone , Vohra Ravinder , Parsons Simon 
Published: November 2024

Abstract

Background
Accurate staging for oesophago-gastric cancer is important in ensuring correct treatment pathways, avoiding unnecessary surgery and providing prognostication for patients. Previously, cross sectional imaging in accurately providing tumour (T) and nodal (N) staging has been variable for upper GI malignancies, with usage of invasive investigations such as EUS to provide more specific local staging. With the increased utilisation of specialist multidisciplinary involvement and improved technology, we aimed to assess whether CT and PET imaging may be able to provide sufficiently accurate staging required for treatment decision making.

Method
All patients who underwent oesoophagogastric resections between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric cancer, and underwent curative resection without neo-adjuvant treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, and final histology. Outcomes assessed included rate of understaging in clinical and pathological T and N staging, and sensitivity and specificity of imaging in identifying presence of nodal disease.

Results
38 patients were included in this analysis. For oesophageal and GOJ cancers, T stage under-reporting occurred in 6/27 (22%) patients, and N under-reporting in 7/27 (27%) patients. Radiological staging correlated with final pathological staging in 55% of T staging and 59% of N staging. Sensitivity (55.56%, 95% CI 21-86%) and specificity (72.2%, 95% CI 46.5-90.3%) for nodal disease on CT/PET was low, however no tumour or nodal under-staging would have impacted management.
Gastric cancer staging accuracy assessment was limited by small numbers (n=12), however T under-staging occurred in 5/12 (42%) patients and N under-staging occurred in 5/11 patients (45%).

Conclusion
Involvement of dedicated radiology services in multidisciplinary care for oesophago-gastric cancer provides adequate radiological staging to guide treatment. Gastric cancer clinical staging requires laparoscopic and endoscopic assessment for accurate tumour assessment and management guidance. Radiological under-staging is less common in oesophageal and GOJ tumours than gastric cancer and has minimal impact on patient management.
OGC SO41 - Omentopexy Technique in Robotic Assisted Minimally Invasive Oesophagectomy
Authors: Mitchell Benjamin , Morman-Dodd Jessie , De Rosa Antonella , Alqudah Abdallah , Lasheen Omar , Cotton Arthur , Dwerryhouse Simon , Upchurch Emma , Vipond Mark , Higgs Simon , Hornby Steve 
Published: November 2024

Abstract

Background
Laparoscopic omentopexy has been shown to reduce the rates of post-oesophagectomy diaphragmatic hernia (PODH) in a retrospective cohort study in a UK specialist centre. We aimed to demonstrate the technique during robotic-assisted minimally invasive oesophagectomy (RAMIE) with video capture.

Method
The Versius (CMR Surgical) robotic system was used in the abdominal stage of RAMIE performed on a 63 year old male with a poorly differentiated oesophageal adenocarcinoma. No previous abdominal surgery had been performed on this patient. Video capture was used to record this part of the procedure.

Results
Ports were inserted in standard configuration to allow fashioning of a gastric conduit. Following this the greater omentum was secured to the anterior abdominal wall around the jejunostomy site. No immediate complications were observed.

Conclusion
The Versius system can be used to successfully perform omentopexy with standard port positioning. Omentopexy was successfully performed with no immediate complications, did not significantly prolong procedural time and may reduce risk of PODH. The authors support the use of this technique in robotic-assisted surgery for reducing risk of PODH and support further work to validate this technique in cohort studies.
OGC SO43 - Management of oesophageal adenocarcinoma in the Covid-19 Pandemic – What have we learnt?
Authors: Goh Yan Mei , Claridge Abigail , Gillies Richard 
Published: November 2024

Abstract

Background
The management of oesophageal adenocarcinoma in the UK has been standardised to neoadjuvant chemotherapy followed by surgery. However, during the early phase of the Covid-19 pandemic, oesophagectomy was considered to be too high risk, and alternative treatment options were explored . In our unit, patients were offered definitive chemoradiotherapy with a view to performing salvage oesophagectomy if there was residual disease or disease recurrence.

Method
We retrospectively screened all patients referred to the UGI MDT between March 2020 to February 2021. Patients included were those with first diagnosis of oesophageal carcinoma, on the curative pathway, planned neoadjuvant FLOT chemotherapy and oesophagectomy then converted to definitive CRT (dCRT). Data collected were patient demographics, cancer staging and cancer outcomes including progression to salvage surgery, disease free survival and overall survival at 1 year and 3 years post treatment.

Results
Ten patients with distal or junctional adenocarcinoma were included. Median age at diagnosis was 70.5 years. Five patients had T3 or T4 disease. All patients had N0 disease. After one year, one patient had undergone salvage surgery for residual disease and two for recurrent disease. One other patient was unfit for surgery and not offered salvage surgery. At three years, only two patients had no disease recurrence. Nine of 10 patients were alive at one year and seven alive at three years.

Conclusion
The Covid-19 pandemic was an unusual event in our most recent history that influenced the way we managed patients with oesophageal adenocarcinoma. Little data exists as to what alternative treatments were effective. Our limited data indicates that dCRT may be used as an alternative to surgery in a subgroup of patients – although disease recurrence was common, 3-year survival was high (70%). Our data appears to be comparable to 3-year survival in our own unit and that reported in NOCGA 2024 (63%). Nevertheless, these numbers are small and thus require further study.
OGC SO46 - Improving outcomes after oesophagectomy: The benefits of full robotic-assisted minimally invasive oesophagectomy (RAMIO) demonstrated in the first 100 cases, at a high-volume UK unit
Authors: Rayner Charles , Paine Heidi , Mahmood Fahad , Luangsomboon Aphiwat , Mcguire Anna , Walker Robert , Madhavan Anantha , Singh Pritam , Abbassi-Ghadi Nima , Preston Shaun 
Published: November 2024

Abstract

Background
There is a rapid movement towards adoption of robotically assisted minimally invasive oesophagectomy (RAMIO) in the United Kingdom. Transition from an open or laparoscopic oesophagectomy to a RAMIO programme, which carries considerable financial and training cost, must ensure parity of oncological and perioperative outcomes. We sought to compare our centre’s results of the three standard approaches to two-phase oesophagectomy: Open/Open (Open); laparoscopic/robotic abdomen with open chest (Hybrid); and RAMIO.

Method
This prospective cohort study investigated the experience of five surgeons in a single high-volume UK institution. We analysed consecutive patients undergoing two-phase transthoracic oesophagectomy for oncological reasons between 2018 and 2024. The study period was divided into three cohorts: Open (2018-2020, n=61), Hybrid (2020-2023, n=82) and RAMIO (2023-2024, n=100). Patient demographics, tumour characteristics, perioperative outcomes, and oncological data were compared. Data were analysed using Kruskal-Wallis and Chi-squared statistical tests.

Results
No significant differences were observed in patient demographics or tumour stage between the groups. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a significant reduction in major complications (Clavien-Dindo ≥III), 34.4% vs. 23.2% vs. 14% (p=0.0014); pulmonary complications, 36.1% vs. 25.4% vs. 13% (p=0.0004); anastomotic leak rate, 11.5% vs. 2.4% vs. 4.0%, (p=0.0370); median length of stay, 14 vs. 12 vs. 8 days (p=0.0001); and mortality, 4.9% vs. 1.2% vs. 0% (p=0.0133) all favouring the RAMIO group in sub-group analysis. Median lymph node yields were comparable across groups, 49 vs. 43 vs. 43 (p=0.0876).

Conclusion
This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAMIO for oesophagectomy. RAMIO was associated with significantly reduced pulmonary complications, major complications and a shorter length of hospital stay. Oncological outcomes were maintained across all 3 techniques. These findings have important patient, financial, and resource implications, and support the continued adoption of RAMIO in the UK.
BN SO04 - The value of routine histopathology analysis of gallbladder specimens after elective and emergency laparoscopic cholecystectomy
Authors: Elafandy Abdelrahman , Riaz Amjad 
Published: November 2024

Abstract

Background
Gallbladder cancer is not among the 20 most common cancers in the UK, accounting for less than 1% of all new cancer cases with a peak rate at 85-89 years of age. There is a dominant routine conception among surgeons to send the gallbladder specimen for histopathology even if there is no gross features that raise suspicion for neoplasm.
In this study, we are trying to get evidence of the value of routine histopathology analysis of gallbladder specimens after elective and emergency laparoscopic cholecystectomy surgeries in Warwick hospital.

Method
The record of all the patients who underwent laparoscopic cholecystectomy ( elective, expiated and emergency ) in Warwick hospital in the period between 01/07/2023 – 30/01/2024 ( 7 months) were collected, reviewed and underwent data analysis

Results
A total of 171 specimens were sent for histo-pathology analysis. Only one patient had low grade dysplasia with no malignant features. No routine follow-up decided for him/her after upper GIT MDT discussion. The incidence rate was 0% of neoplasm and 0.6% of low-grade dysplasia.

Conclusion
No specimen in the study had suspicious gross features of malignancy. Using a selective system is more logical and economic than the routine sending for histopathology after elective and emergency laparoscopic cholecystectomy if there are no suspicious features in the specimen.