bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P21 Discrepancy between the clinical and final histopathological staging of locally advanced oesophageal adenocarcinoma
Authors: Hraishawi Ihab , Deeny Dearbhla , Gray Ronan , McCain Scott , Harris Andrew , MacAulay Graeme , Kennedy Raymond , Kennedy Andrew 
Published: November 2023

Abstract

Background
Accurate staging of locally advanced oesophageal cancer plays a pivotal role in treatment planning and prognostic counselling for the patients. Clinical staging employs various imaging modalities to guide treatment decisions and predict outcomes. This study aimed to compare clinical staging (post neoadjuvant chemotherapy) with the final histopathological staging in patients with locally advanced oesophageal adenocarcinoma undergoing oesophagectomy at Belfast Health and Social Care Trust.

Methods
A retrospective analysis was conducted on a cohort of 81 patients diagnosed with locally advanced oesophageal adenocarcinoma who underwent neo-adjuvant chemotherapy followed by oesophagectomy at Belfast Trust between March 2020 and March 2022. Patients with squamous cell carcinoma, those who proceeded directly to surgery and those treated with salvage oesophagectomy following previous radical chemo-radiotherapy were excluded from the study to minimise heterogeneity. Two independent radiologists reviewed the restaging PETCT scans and validated the clinical staging. The post neoadjuvant clinical staging was subsequently compared to the final histopathological staging obtained from surgical resection specimens.

Results
Among the 81 patients included in this study, a significant proportion of patients were upstaged (53%) or downstaged (31%). The combined T&N staging accuracy was observed in only 13 patients (16%). 21 patients (26.3%) had their T staging downstaged on final assessments. Nodal staging discrepancies were observed in 35 cases (43.2%) upon final histopathological assessment. These isolated nodal discrepancies primarily involved nodal upstaging, with 14 patients upstaged from N0 to N1 and 13 patients upstaged from N0 to N2.

Conclusions
The accuracy of clinical staging for oesophageal adenocarcinoma remains poor. Our study revealed notable discrepancies in nodal staging between clinical and final histopathological staging. Approximately 43.2% of patients had isolated nodal discrepancies, primarily involving nodal upstaging. These findings emphasize the challenges in accurately assessing nodal involvement and highlight the need for improved staging methods to guide optimal treatment for locally advanced oesophageal adenocarcinoma. The topic of whether the routine use of EUS is justified for evaluating regional lymphnodes and enhancing staging remains a subject of debate, notwithstanding the limitations and challenges inherent to EUS.
OGC P30 Prophylactic HIPEC and Intro-Operative Radiotherapy (IORT) in the Management of Gastric Cancer: An international retrospective case-control study
Authors: Aldaghiri Khalid , Worthington Lucy , Alyahya Zyad , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
The combination of surgery and peri-operative chemotherapy is a well-established cornerstone of treatment with curative intent for gastric cancer in the UK. However, this approach has not necessarily been adopted globally. Hyperthermic intraperitoneal chemotherapy (HIPEC) and intraoperative radiation therapy (IORT) may improve survival amongst patients with advanced gastric cancer, however the evidence base for its use is limited and its efficacy remains unclear. The present study investigated the effectiveness of prophylactic HIPEC and IORT compared to peri-operative chemotherapy and gastrectomy in patients with gastric cancer.

Methods
A retrospective study including patients with gastric adenocarcinoma (stages 1-3) between 2014 and 2020 was undertaken. All patients received peri-operative chemotherapy and radical gastrectomy in an academic surgical centre in the Kingdom of Saudi Arabia or a regional tertiary oesophago-gastric centre in the North-West of England. Two groups were formed – one (study group – KSA; HIPEC-IORT) which also received combined prophylactic HIPEC and IORT and one which did not (control – UK; CS). Three parameters were utilized as control variables (age, gender, tumour stage and location). 2:1 matching between the control and study group (86 vs 43 patients) was performed.

Results
Mean age was 60 (SD = 14.5; 81.5% male). R0 rates were 74.5% in the HIPEC-IORT group vs 82.5% in the CS group. LVI and PNI rates were higher in the HIPEC-IORT group (55.8% vs 32.6%)(55.8% vs 32.6%) as were rates of diffuse-type morphology (39.5% vs 17.5%). Pathological stage distribution in the study group was different (37.2% II and 62.8% III) vs (31.4% I, 34.9% II, 33.7% III). Cox regression analysis which controlled for age, gender, and cancer stage, found no difference in survival between HIPEC-IORT and CS groups (p=0.219).

Conclusions
The findings of the present study suggest that the combination of prophylactic HIPEC and IORT following radical gastrectomy cancer does not significantly improve survival. Further exploration which compares the short-term outcomes of both approaches is required. These results should be interpreted with caution as the groups showed morphologically different tumour-types. A larger prospective study which controls for more variables may be warranted.
OGC P32 Preoperative hand grip strength is associated with postoperative pulmonary complications after major abdominal surgery: a prospective multi-centre international cohort study
Authors: Sellayah Renishka , Boden Ianthe 
Published: November 2023

Abstract

Background
Low muscle strength is a primary indicator of sarcopenia, defined by the European Working Group on Sarcopenia (EWGSOP2) and is related to postoperative complications after major surgery. Handgrip strength is easily measured preoperatively and is an alternative to skeletal muscle index assessments, which are time consuming and require specialised equipment. The current studies pertaining to handgrip and postoperative outcomes are largely retrospective, single-centre studies in populations dissimilar to Australian and New Zealand surgical patients.

Methods
Patient-level data from the Lung Infection Prevention Post Surgery – Major Abdominal – with Pre-Operative Physiotherapy study (ANZCTR 12613000664741), a randomised controlled trial conducted across three Australian and New Zealand tertiary hospitals (2013-2015) was utilised. Eligible patients were those listed for elective upper abdominal surgery. Maximum dominant handgrip was measured via standardised methods. Percentage of predicted handgrip was calculated using recognised normative values; &lt;85% predicted was set as signifying low handgrip strength. The association between &lt;85% of predicted handgrip and postoperative outcomes was analysed using multivariate regression modelling adjusted for covariate effects of age, gender, ASA, smoking status, and type of surgery.

Results
Of 432 participants (50% colorectal, 25% UGI/HPB) hand grip data was available for 379 (88%). Patients with low preoperative handgrip had a four-fold increased risk of developing a postoperative pulmonary complication (RR 3.95; 95% CI 1.09 to 14.2; p=0.037) independent of other confounding variables. Handgrip had the strongest effect on postoperative pulmonary complications compared to age, gender, upper gastrointestinal, hepatobiliary surgery, ASA, and current smoking. There were consistent signals of a relationship between preoperative weak hand grip and MET calls, extraordinary physician ward consults, prolonged length of hospital stay (&gt;14 days), sub-acute stays, and longer time to independent mobilisation.

Conclusions
This is the first study of handgrip in Australian and New Zealand surgical patients. It prospectively validates previous findings that weak handgrip is related to worse postoperative outcomes, particularly respiratory. Intriguingly, handgrip had a stronger effect on pulmonary complications than upper GI or hepatobiliary surgery. Finally, given its ease of measurement, handgrip can be assessed at first clinical contact, increasing the time available for pre-habilitation.
OGC P37 Long term follow-up of patients undergoing prehabilitation prior to oesophagectomy: What happens to patients declining or withdrawing from prehabilitation exercise programmes?
Authors: Knight William , Moore Jonathan , Whyte Greg , Zylstra Janine , Lane Andy , Pate James , Gervais-Andre Louise , Maisey Nick , Hill Mark , Tham Gemma , Lagergrens Jesper , Kelly Mark , Baker Cara , Van Hemelrijck Mieke , Goh Vicky , Gossgae James , Browning Mike , Davies Andrew 
Published: November 2023

Abstract

Background
Prehabilitative exercise prior to cancer surgery can improve survival, health-related quality of life and chemotherapy completion and response rates. Little is known about patients who either drop-out or decline to participate in exercise programmes in oesophageal cancer. This study reports the outcomes of patients who declined or dropped out of the Pre-EMPT trial prior to neo-adjuvant chemotherapy (NAC) and oesophago-gastrectomy.

Methods
A prospective non-randomised, cohort-controlled trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal cancer. Kaplan-Meier and multivariable Cox regression analyses were used to compare overall and disease-free survival between the trial patients (intervention and control) with patients who declined participation or dropped out of the study (non-participants).

Results
21 patients completed the exercise intervention, 20 patients were enrolled in the control group, and 24 patients either dropped out (9) or declined to participate (15). All underwent NAC and oesophago-gastrectomy. Baseline comorbidity, post-operative complication rates and length of stay were similar between all groups. Kaplan Meier survival analysis showed no difference between the intervention and control groups but a significant survival disadvantage in the non-participants (p=0.03). On multivariable analysis mortality hazard ratio was significantly higher in the non-participant group (HR 95%CI3.44; 1.05-11.28).

Conclusions
Patients who dropped out or declined to participate in the PRE-EMPT study experienced poorer survival compared to both the intervention and control groups. This survival disadvantage is likely to be multifactorial. However, these patients represent an important group, currently inaccessible to prehabilitative programmes, who may have the most to gain from such an intervention.
OGC P40 An exploration into the duration patients undergoing surgical resection of Oesophageal or Gastric cancers require specialist Upper Gastrointestinal dietetic support
Authors: Dossou Vida 
Published: November 2023

Abstract

Background
Patients recovering from UGI resection are nutritionally complex, vulnerable, and face multiple dietetic challenges. Surgical guidelines exist in terms of gold standard follow up for UGI Cancer patients in UGI surgical clinics, however currently there is no guidance on how long they require intensive, specialist UGI dietetic support. Disparity exists amongst surgical centres in terms dietetic resource and service provision, thus no guideline on how long to keep under the tertiary UGI dietetic care currently exists. As an established, regional, UGI surgical dietetic service, an audit was conducted discerning the specialist UGI dietetic need for 5 years post resection.

Methods
A retrospective audit was conducted observing follow up of patients undergoing UGI surgery at a tertiary centre for UGI surgery in 2018. All patients had undergone Oesophagogastrostomy (OG), Total Gastrectomy (TG), or Sub-Total Gastrectomy (STG) and were under the care of the UGI RD by means of a blanket referral system. Patients were followed up by UGI surgery for 5 years. Electronic patients’ records were utilised, and the following information was collected per patient: Type of surgery, Number of dietetic contacts, Duration of follow up, Type of diet. This was collated, type of diet was compared, and average values obtained.

Results
Our results demonstrated that UGI surgical patient’s require significant specialist UGI RD follow up post resection regardless of the type of surgery. In terms of complexity, OG patients were most challenging with multiple dietetic interventions at the same time to meet nutritional needs and manage malabsorption. In all cases, the most prevalent intervention was using diet and Oral Nutritional Support. Surprisingly, STG required the longest dietetic follow up at almost double that of TG. OG patients required the second longest duration of specialist UGI dietitian follow up, however the most dietetic contacts, reiterating that their input was more intensive.

Conclusions
This audit identifies the need for specialist, frequent UGI dietetic support for at least 31/2 years post UGI resection, ideally at an experienced tertiary surgical centre. Whilst OG patients require more intensive dietetic support, TG and STG also have an equally long-term dietetic need. This data spreads across the pandemic period, therefore opportunities for follow up may have been impacted, thus this data could be an underreporting. It would be prudent to repeat this audit on post pandemic resections to ascertain if more frequent, longer term UGI dietetic review is observed. Further audit should include readmission rates, and patient feedback.
OGC P44 Biospectrometry as a non invasive tool in the diagnosis of oesophageal cancer
Authors: Elniel Mohammed , Maitra Ishaan , Ur Rehman Ihtesham , Daté Ravindra 
Published: November 2023

Abstract

Background
Oesophageal adenocarcinoma (OAC) typically presents at an advanced stage with resultant poor survival rates. The 2022 oesophago-gastric (OG) audit suggests only 35.9% of patients diagnosed with OG cancer were treated with curative intent.
Raman spectroscopy of serum is a non-invasive and rapid diagnostic technique which has proved promising in cancer diagnostics. A proof-of-concept study of 124 samples undertaken by our team to determine the accuracy of Raman spectral discrimination in detecting oesophageal transformation of Barrett’s to adenocarcinoma revealed sensitivity and specificity of over 95% when using serum to diagnose OAC.

Methods
Our research group has conducted a further study to validate the aforementioned findings by re-analysing 60 samples from the proof of concept study in a separate laboratory. Chemometric techniques, coupled with principal component analysis, were employed to identify discriminant spectral peaks. Subsequently, a prediction model was developed using a linear discriminant analysis algorithm to accurately classify serum samples from cancer patients.

Results
Spectral peaks representing methylene deformation at 1450 cm-1 and C-O stretch of ribose at 1012 cm-1 were identified as discriminant spectral peaks in identifying OAC in both analyses, inferring that these results are reproducible. A specificity and sensitivity of 72% and 71% respectively was calculated from chemometric spectral analysis.

Conclusions
We conclude that Raman spectroscopy has potential applications as a non-invasive screening tool for patients with suspected OAC.
OGC P46 A consensus opinion on the best prehabilitation strategies for Upper GI cancer patients
Authors: Moody Negar , Moody Paul , Mahmood Fahad , Veenith Tonny , Tan Benjamin 
Published: November 2023

Abstract

Background
Upper GI (UGI) cancer patients face substantial physical and functional challenges which can compromise postoperative recovery. Prehabilitation, a proactive multidisciplinary intervention, offers a promising approach to optimize patient outcomes. This Delphi exercise aims to gather a consensus on the effectiveness of various prehabilitation strategies and interventions in improving functional capacity, reducing treatment-related complications, and enhancing quality of life among UGI cancer patients.

Methods
We performed a Delphi exercise in the form of an online survey emailed to a group of surgeons, anaesthetists, specialist nurses and allied healthcare professionals involved in the perioperative care of UGI cancer patients. A 2-staged iterative process was used to gather consensus on clinical practice and expert opinion. In the second round the survey was refined to evaluate specific strategies of prehabilitation more closely.

Results
In the first round, 14 statements were evaluated in addition to basic demographic data, information about the unit and clinician experience. 161 responses were collected from surgeons, anaesthetists, specialist nurses and allied healthcare professionals. Consensus was reached on formal assessment of patient fitness pre-operatively. However no consensus was achieved in the best method for doing so. In the second round we evaluated 22 statements after refining the questions to specifically target prehabilitation exercises and formal fitness assessments available for the perioperative care of UGI cancer patients.

Conclusions
Prehabilitation interventions hold significant potential in optimizing outcomes and improving the quality of life for UGI cancer patients undergoing major surgery. This Delphi exercise provides multidisciplinary expert consensus statements which can help guide clinicians in day-to-day practice as well as provide a basis for future guidelines and recommendations.
OGC P47 Yield of staging laparoscopy in upper GI cancer; post COVID
Authors: Ahmed Salman , Shetty Vinutha , Ward Jeremy , Singh Mohan , Turner Paul , Pursnani Kish 
Published: November 2023

Abstract

Background
Staging laparoscopy is a useful adjunct in preoperative staging process of oesophago-gastric cancer. NICE recommends use of staging laparoscopy in oesophageal cancer cases where it is likely to guide further management. In cases of gastric cancer there is strong evidence to suggest a high specificity of staging laparoscopy in detection of peritoneal metastasis. During COVID very selective use of staging laparoscopy was adopted by our unit. In this study we aimed to evaluate yield of staging laparoscopy in context of gastric and selective oesophageal cancers in our unit during post-COVID period

Methods
Retrospective analysis of our prospectively kept database in patients undergoing staging laparoscopy between January 2022 to May 2023 in upper GI tertiary cancer centre was performed. Age, sex, tumour grade, nodal status on radiology, histologic type, differentiation, and site of tumour was assessed against positive cytology and presence of peritoneal or occult visceral metastasis. Multivariate logistic regression was applied to identify independent factors associated with findings. Statistical analysis was carried out using EXCEL® and MedCalc® software.

Results
Among 104 patients, 69 had oesophageal cancer (OC) and 35 had gastric cancer (GC). In OC group cytology was positive in 4 (5.8%), peritoneal metastasis was present in 7 (10.1%) patients. In GC group positive cytology in 8 (22.8%), peritoneal metastasis was found in 8 (22.8%) patients. On multivariate analysis differentiation, T3+ tumour, lower third cancer, male sex was linked with positive findings in OC group. In GC group poor differentiation, T4 disease, mid body tumour, nodal status of N3 were associated positive findings. Yield of laparoscopy was found to be 17.6% and 34.6% in OC and GC groups respectively.

Conclusions
Despite of recent advances in radiological modalities, staging laparoscopy remains a useful adjunct in diagnosing peritoneal disease. With negligible complication rates and its relatively high yield in lower third and junctional oesophageal cancer it can be utilised to guide further management and reduce unnecessary laparotomies. Mid gastric body site and T4 cancers in our cohort were strong predictors of peritoneal disease further multi centre research on site of tumour is needed to affirm any such association.
OGC P48 The Relationship between Hospital Acquired Pneumonia (HAP) and Synchronous Post-Operative Complications following Oesophagectomy: An Assessment of the impact on mortality
Authors: Waheed Unaiza , Alvi Quraishi Rumaysa , Patel Minal , Worthington Lucy , Fidler David , Heal Calvin , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Hospital Acquired Pneumonia (HAP) is a frequently occurring complication following oesophagectomy, often associated with poorer outcomes. After oesophagectomy, HAP can occur in conjunction with other pulmonary and non-pulmonary complications such as anastomotic leak. Single lung ventilation during oesophagectomy can lead to altered lung function, contributing to infective and non-infective respiratory complications. Understanding the interplay between these factors is crucial for recognizing the multifaceted nature of HAP and identifying areas of focus to reduce its incidence. This study aimed to quantify the incidence of HAP in relation to other complications, and assess the effect of pulmonary complications on long-term outcomes.

Methods
This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG cancer centre serving a population of 3.5 million people between 2014-2022. Data was extracted from the Electronic Patient Records. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. Clinical details and radiological reports (Computed Tomography and Chest X-Ray) on the day of HAP diagnosis (defined using the CDC criteria) were recorded, alongside evidence of pneumothorax, pleural effusion, emphysema and Acute Respiratory Distress Syndrome (ARDS). Complications were defined using the Esophagectomy Complications Consensus Group (ECCG) definitions. Survival analysis was conducted on STATA.

Results
460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP - 56 (12.2%) met the CDC criteria. 125 (60.10%) patients treated for HAP had concurrent pleural effusion, 60 (28.85%) pneumothorax, & 12 (5.77%) surgical emphysema. 53 patients (25.49%) had two concurrent findings. 17/53 (32%) patients with anastomotic leak also had HAP. 5-year OS between patients treated for HAP who met the CDC criteria versus those who did not meet the criteria were similar. There was no difference in OS between patients with HAP versus no respiratory complications. Patients with no complications had the highest 5-year survival.

Conclusions
A significant proportion of patients develop HAP after oesophagectomy, usually alongside concurrent pulmonary complications. A significantly higher number of patients were treated for HAP than met the CDC criteria, highlighting the complexity in diagnosing post-operative complications. Our results suggest that a diagnosis of HAP is not a predictor for poorer long-term survival. Further research is warranted to elucidate the underlying mechanisms and refine treatment approaches in this patient population.