bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P10 Implementation of an Oesophago-Gastric Robotic Programme in a Tertiary Centre and the Evolution to a Structured Training Programme for Career OG Trainees
Authors: Paine Heidi , Bull Alexander , Abbassi-Ghadi Nima , Singh Pritam , Madhavan Anantha , Preston Shaun R 
Published: November 2023

Abstract

Background
Robotic surgery affords advantages over standard laparoscopic surgery, for both patients and surgeons. Robot-assisted minimally invasive oesophagectomy (RAMIO) has demonstrated shorter operative time and improved lymph node yield (RAMIE trial). Benefits to the surgeon, and patient, include enhanced visualisation, greater precision, and improved ergonomics. During any transition to robotic surgery the need to maintain patient safety and outcomes, especially during the learning curve, is paramount. The impact on training should not be underestimated, with lost opportunities for trainees to develop procedural competence whilst on rotation. We describe the evolution of a robotic oesophago-gastric programme in a tertiary upper GI centre.

Methods
Implementation began in 2019 with online modules, simulation, and wet-lab workshops. There was external proctorship of the first two consultants for fundoplication then again for thoracic–phase robotic surgery 28 months later. Meanwhile these consultants facilitated the training of consultant colleagues to ensure a whole-team transition to robotics. This rapidly led to the introduction of component-based training of senior trainees in all abdominal aspects of robotic UGI surgery. This will ultimately progress to training career OG cancer surgeons in full RAMIO. Throughout the implementation process, regular audit allowed us to ensure that there was no adverse impact on patient outcomes.

Results
246 robotic UGI procedures were performed since September 2020, progressing step-wise from anti-reflux to RAMIO. Initially two consultants were trained, with staged introduction of two others. Subsequently, senior trainees commenced training in sequential components of procedures. Since progression to full RAMIO, the majority (82%) of two-phase oesophagectomies have been robotic. Of non-robotic, one (3%) abdominal conversion for bleeding, one planned open abdomen, and 12% due to a lack of robot access. Introduction of training of non-consultant grades in June 2022 occurred in parallel with thoracic phase training of three consultants. Trainees performed substantial components of 33/130 cases over this time.

Conclusions
We report the structured, stepwise evolution of an oesophago-gastric robotic programme in a tertiary centre up to full RAMIO with the inclusion of in-house mentoring and training of career OG trainees. Weekly robotic operating lists and high throughput of cases have facilitated uptake across all surgeons and in the majority of cases. The uptake across all consultants has facilitated relatively early on-console training of senior trainees to minimise the impact upon their career development. As an established service with full team engagement, moving forward we anticipate even greater robotic access and trainee involvement.
OGC P11 Outcomes in patients with gastric cancer and positive peritoneal washings
Authors: Andrea Cross , Phillips Alexander , Immanuel Arul , Wahed Shajahan , Hayes Nick 
Published: November 2023

Abstract

Background
The presence of positive cytological washings in the absence of overt peritoneal disease (P0C1) represents metastatic disease. Most centres advocate for neoadjuvant chemotherapy and full restaging including repeat laparoscopy and washings, with resection offered to those in whom restaging is negative. This approach was implemented at our institute in 2012 and when evaluated in 2015 was found to have very good results with 63% of patients resected and 90% 2-year survival.
Since this time chemotherapy regimens have changed meaning this earlier approach requires additional scrutiny.

Methods
A retrospective review of a prospectively maintained database of all upper GI cancer patients treated at the Northern Oesophago-Gastric Unit (NOGU) was undertaken. All patients with adenocarcinoma of the stomach or gastroesophageal junction without metastases on imaging and who underwent staging laparoscopy between August 2012 and August 2022 were identified. Patients who had positive cytological washings without evidence of overt peritoneal disease were included in the analysis. Data were extracted including demographics, treatment data and oncological outcomes. Survival data were collected and patterns of recurrence determined.

Results
630 patients underwent staging laparoscopy. Resectable P0C1 disease occurred in 55/630 (8.7%), and 48/55 commenced chemotherapy. Restaging occurred in 45/48 (93.8%) and 21/45 (46.7%) went on to have definitive surgery where 15/45 (33%) were resected.
Recurrence occurred in 8/15 patients, 3 of which had peritoneal metastases. Median time to recurrence was 16 months (range: 6-34). A total of 9 patients died during follow up which occurred at a median of 14 months (range: 5 to 43). Overall median survival of the cohort was 28 months (range: 5 – 111), with survival of 60% and 25% at 2 and 5 years, respectively.

Conclusions
This study demonstrated 60% 2-year survival in patients treated with curative intent who initially had positive peritoneal cytology. We were not able to demonstrate a predominate pattern of peritoneal recurrence. Furthermore, 25% of patients survived for at least 5 years after surgery, indicating that this remains an acceptable approach to the management of P0C1 disease with current best practice chemotherapy regimens.
OGC P13 CNS and Dietitian led clinical follow-up with support from a survivorship multi-disciplinary team meeting: A model of care for patients after oesophago-gastric (OG) cancer surgery
Authors: Evans Orla , Taylor Joanna , Baker Cara , Kelly Mark , Knight William , Hegarty Jane , Henggeler Cordula , Rusu Oliviana , Mundle Georgia , Gossage James , Dunn Jason , Zeki Sebastian , Davies Andrew 
Published: November 2023

Abstract

Background
Major upper gastro-intestinal (UGI) cancer surgery in combination with chemotherapy offers the best chance of cure for patients with oesophageal and gastric cancer. However, these treatments have significant long-term side-effects resulting in a high symptom burden in this patient group. This adversely affects quality of life and places significant demands on healthcare after surgery. There is a large variation in follow-up services nationally, with little guidance on optimal practice.

Methods
A clinical nurse specialist (CNS) and Dietitian led clinic has been utilised in this patient group for 12 years at St Thomas’ hospital, with UGI surgeon support as required. In 2021, a survivorship multi-disciplinary team meeting (MDM) consisting of CNS, Dietitian, Gastroenterologist, UGI surgeon and psychologist was introduced. This aimed to support the clinic by discussing management of complex cases.

Results
Since 2011, approximately 3000 patient consults have been undertaken in the survivorship clinic. These patients benefited from specialist follow-up, expertise in symptom management, holistic needs assessments, recurrence surveillance and specialist dietetic advice. These patients were removed from surgical and oncology out-patient clinics, creating greater capacity in these services. Patient feedback has consistently supported this model of follow-up. Complex patients are discussed in the survivorship MDM which supports the clinic.

Conclusions
CNS and Dietitian led clinics, alongside a survivorship MDM, may provide a better model of follow-up compared to traditional surgical clinics by offering a greater breadth of expertise and consistency of follow-up. Evaluation of patient centred outcomes and economic analysis, in addition to on-going national initiatives to standardise the investigation and management of symptoms following major UGI surgery, would support replicating this model in other centres.
OGC P14 Robotic-assisted Minimally Invasive Oesophagectomy using the Versius System: Initial Experience and Short Term Outcomes from a Tertiary Oesophagogastric Cancer Centre
Authors: Slim Naim , Higgs Simon , Hornby Steve , Dwerryhouse Simon 
Published: November 2023

Abstract

Background
Oesophagectomy is the gold standard treatment for patients with early or locally advanced oesophageal cancer. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality, and whilst such methods have traditionally employed a combination of laparoscopic and thoracoscopic approaches, the use of the robot has additionally conferred a greater degree of dexterity and precision for the operating surgeon. The Versius(R) system (CMR Surgical) has a modular design comprising individual arms which offers flexibility with patient positioning. Despite its uptake, the feasibility and safety of the Versius system with minimially invasive oesophagectomy has not been characterised.

Methods
We performed a retrospective review of patients operated with curative intent for oesophageal cancer between October 2021 and March 2023. Patients who underwent robotic-assisted oesophagectomy were included in the study, including hybrid and fully robotic approaches. Data pertaining to short term post-operative and oncologic outcomes was obtained and analysed.

Results
Seventeen robotic-assisted oesophagectomies were performed. Sixteen (94.1%) underwent a hybrid approach; eight (47.1%) with laparoscopic abdomen and robotic thoracic phases, and the remainder with robotic abdomen and open thoracic phases. One (5.9%) underwent fully robotic abdominal and thoracic oesophagectomy. There were four (23.5%) unplanned conversions to thoracoscopic or laparoscopic surgery. The median operating time was 454 minutes, and length of stay was 11 days. Five patients suffered a major (Clavian-Dindo &gt;III) compllication. There were no deaths within 90-days of sugery. The median lymph node harvest was 23.5 nodes, and a microscopically margin-negative (R0) resection was achieved in 87.5% of cases.

Conclusions
Our experience with the CMR Versius System is that of safety and feasibility, and suitability for both the abdominal and thoracic phase of minimially invasive oesophagectomy. Further studies are warranted to assess longer-term oncologic and survival outcomes.
OGC P20 A Systematic Mapping Review of Core Outcome Reporting in Surgical Research for Oesophageal Cancer
Authors: Matias Nadia , Thomson Jack , Naqvi Anie , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
The UK has one of the highest rates of oesophageal adenocarcinoma worldwide. Surgical resection, with peri-operative chemotherapy, is the cornerstone of curative treatment. The evidence base for which surgical approach is best (including open, hybrid, totally laparoscopic/thoracoscopic, and robotic surgery) is negatively affected by heterogeneous reporting of outcomes. This study examines the degree to which outcomes deemed critically important to patients and healthcare professionals (a core outcome set - COS) are reported by studies in this field.

Methods
We undertook a mapping review of prospective cohort studies, randomized controlled trials (RCTs), and published protocols in the field of oesophageal cancer surgery. Evidence Based Medicine Reviews, MEDLINE, EMBASE, and CINAHL were searched for relevant studies conducted over a 10-year period (2011-2021). We mapped the reporting of 10 core outcomes during this period as described by a COS for oesophagectomy trials (overall survival; in-hospital mortality; inoperability; the need for additional intervention; respiratory complications; conduit necrosis and anastomotic leak; severe nutritional problems; the ability to eat and drink; problems with acid indigestion or heartburn and overall quality of life).

Results
Initial searches identified 8944 potentially eligible records, which, after exclusion of duplicates, abstract screening and full paper reviews, yielded 57 eligible studies that recruited 10,561 patients (36 prospective cohort studies, 16 RCT’s and 5 published protocols). No study reported all core outcomes. The median number of outcomes reported was 4 (IQR 3). ‘In-hospital mortality’ (86%), ‘conduit necrosis/leak’ (81%) and ‘respiratory complications’ (79%) were reported by most studies. ‘Quality of life’ (26%), reflux symptoms’ (21%) and 'severe nutritional effects' (19%) were rarely reported alongside ‘need for reintervention’ (16%). No improvement in reporting rates was seen during the study period.

Conclusions
The reporting of core outcomes in surgical research for oesophageal cancer does not adequately reflect the priorities of patients and healthcare professionals. Further work is therefore needed to significantly improve the reporting of these core outcomes and increase the methodological quality of studies in this field. The results from this study suggest that there is a need for further high-quality prospective studies and RCTs which encompass the reporting of core outcomes.
OGC P22 The Prevalence of Malabsorption and Use of Pancreatic Enzyme Replacement Therapy Post Upper GI Surgery
Authors: Duffy Niamh 
Published: November 2023

Abstract

Background
Pancreatic enzyme insuffiency (PEI) appears to be under recognised and under treated in upper GI surgery due to limited evidence regarding the prevalence of PEI post operatively. This has potential to exacerbate the risk of malnutrition in an already vulnerable patient group. Pancreatic enzyme replacement therapy (PERT) may influence nutritional status and quality of life after Upper GI surgery, but the research to date remains controversial. A retrospective audit was carried out to review the use of PERT in 233 Upper GI surgeries across a two-year period.

Methods
Retrospective audit documenting all patients that have undergone a GIST resection, distal gastrectomy, subtotal gastrectomy, completion gastrectomy, oesophagectomy and total gastrectomy between 2021-2022 at a tertiary centre for Upper GI cancer surgery. It was recorded from electronic patient records which of these patients were commenced on PERT post operatively. The time frame in which the PERT was initiated was captured, as well as and what dose patients required to provide symptom relief. The duration of PERT prescription was recorded in addition to patients’ tolerance.

Results
Initiation of PERT varied from one month to one year after surgery, with most patients (n=24) commencing PERT within the first month. The final dosage of PERT required varied between 50,000iu (n=36) and 125,000iu (n=6). Many patients remain on PERT (n=53); whilst 26% of individuals stopped PERT within six months due to no benefit found or poor tolerance (n=19).

Conclusions
The use of PERT in one third of surgical Upper GI patients highlights the prevalence of PEI in this patient group. This data indicates the initiation of PERT is higher within the first three months following surgery, with the majority of these patients’ requiring PERT for long term use. A larger, multicentre trial is needed to further analyse the benefits of PERT on weight and quality of life, whilst addressing the potential influence of confounding variables such as disease stage and adjuvant treatment.
OGC P23 Modified Frailty Index is not a good predictive tool of postoperative mortality following minimally invasive oesophagectomy
Authors: Ari Kaso , Sivarajan Sri , Lee Angela , Coleman Alexandra , Kulasegaran Suheelan , Kumar Bhaskar 
Published: November 2023

Abstract

Background
Evaluating frailty in the elderly population is crucial in preoperative assessment to identify high-risk patients. The modified frailty index (m-FI) is known to predict postoperative mortality in various surgical populations, but its predictive value in oesophagectomy patients' long-term mortality is unclear. No studies have specifically quantified frailty and its association with long-term postoperative mortality in oesophagectomy patients. This study investigates the association between m-FI score and long-term mortality in patients undergoing minimally invasive oesophagectomy (MIO).

Methods
The m-FI is a scoring tool of 11 parameters quantifies frailty in surgical patients. Retrospective analysis (1/1/2014-31/12/2023) of patients aged ≥75 years undergoing minimally invasive oesophagectomy procedures for cancer, at a single h[ka1] igh volume tertiary referral centre was carried out. Primary outcome was defined as 1-year all-cause mortality with overall length of survival as the secondary outcome. After sensitivity analyses m-fi score of less than 1 or greater than 2 were most predictive of mortality.

Results
Ninety-one patients (mean age 78 years, age range 75-88, male to female ratio of 4:1) were included, with a median m-FI score of 1 (range: 0-5). Patients with an m-FI score of ≥2 had a higher 1-year mortality rate (30% vs. 19%, p=0.195) and shorter overall median survival time (34 months vs. 47 months, p=0.399) compared to those with a score of ≤1. After adjusting for covariates, including preoperative chemotherapy, age, sex, and cancer staging, an m-FI score of ≥2 had a hazard ratio of 1.65 (95% CI: 0.68 to 3.98, p=0.267) for 1-year mortality compared to ≤1.

Conclusions
The m-FI tool can predict post operative mortality in a range of surgical specialities. The results of our study would suggest that higher m-FI score would correlate with worse long term mortality outcomes, however at this stage the m-FI tool cannot be applied in a clinical setting to accurately define elderly patient's probable outcome following MIO. Additional multicentre data is needed to establish its true predictive value in this patient cohort.
OGC P26 Safety and efficacy of 30mm pyloric balloon dilatation after esophagectomy for treatment of delayed gastric emptying
Authors: Abdelrahman Mohamed , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Chung Tham Ji , Wheatly Tim , Chan David 
Published: November 2023

Abstract

Background
Delayed gastric emptying (DGE) affects up to 37% of patients after esophagectomy and is treated with dilatation of the pylorus with either a 20mm or 30mm balloon. Although pyloric balloon dilatation (PBD) with the 20mm balloon is safe, it may not be as effective as the 30mm balloon. The aim of this study was to assess the safety and efficacy of PBD with a 30mm balloon in the acute setting.

Methods
Details of consecutive patients who underwent esophagectomy for cancer and diagnosed with DGE and underwent PBD between April 2014 to July 2021 were analysed retrospectively from a prospectively maintained database. The main outcome measures were rates of re-dilatation and morbidity.

Results
Out of 584 patients who underwent esophagectomy, 106 patients [71 Male (67.7%), median age (range) 68 (38-81 years)] were diagnosed with DGE (18.2%). Seventeen patients (16%) were treated conservatively. Six patients (5.7%) underwent intra-operative pyloroplasty. A total of 83 patients (78%) underwent PBD. Seventy-one patients (67%) underwent PBD with a 30mm balloon) on the index admission at a median of 9 days (range 2 – 27 days) post-operatively. Two patients (2.8%) developed leaks post dilatation. Patients were discharged home after a median (range) of 4 (1-91) days after PBD. Total length of stay was a median (range) of 13 days (7-119).

Conclusions
Pyloric balloon dilatation with a 30mm balloon is a safe and effective treatment option for delayed gastric emptying after esophagectomy in the index admission.
OGC P31 On the role of Cytosponge for Barrett’s surveillance: assessment of viability and safety of this new technology
Authors: Asarbakhsh Mariam , Singh Gautam , Megson Tyler , McDonald Claire , Olejnik Hannah , Verma Harsh , Saha Arin 
Published: November 2023

Abstract

Background
Barrett’s Oesophagus is a pre-malignant change where the normal stratified squamous epithelium is replaced by intestinal columnar epithelium. Current guidance produced by the British Society of Gastroenterologists describes 'gold-standard' surveillance as regular upper GI endoscopy with quadrantic biopsies for every 2cm length of Barrett’s oesophagus. The Covid pandemic led to significant delays in the Barrett's surveillance; as a result, many patients have fallen outside their maximum recommended surveillance interval. Cytosponge is a novel cytology sampling device which has a potential role in Barrett's surveillance though its use for this condition remains controversial.

Methods
All patients who were due for Barrett's surveillance in 2022 were identified and screened for suitability for Cytosponge, instead of endoscopy. Patients who were ineligible, or who declined Cytosponge, were sent for endoscopy. The remaining patients underwent a Cytosponge procedure as their primary Barrett's surveillance modality. Early clinical outcomes, patient satisfaction and cytology results were recorded. All patients have been followed up to determine if they have subsequently required endoscopy or had an early diagnosis of oesphago-gastric cancer.

Results
193 patients (77%) were suitable for the Cytosponge test. 175 (90%) did not require endoscopy after Cytosponge. 18 patients (10%) had urgent endoscopy after Cytosponge; 9 patients had atypia on cytological analysis, 3 had aberrant p53 and 4 had dysplasia. Three patients had inadequate cytology. 2 of the patients with dysplasia had high-grade dysplasia confirmed on endoscopy; these were successfully treated with radiofrequency ablation. Median follow-up was 14 months (range, 10-22). No patients have been diagnosed with oesophago-gastric cancer so far; 8 patients (4%) were referred later for anaemia or weight loss. None of these patients had oesophago-gastric cancer.

Conclusions
These data suggest that Cytosponge can be a valuable first-line tool in surveillance of Barrett’s Oesophagus. Cytology results identified specific patients who required urgent endoscopy. No patients have had an early diagnosis of dysplasia or malignancy after a Cytosponge that was normal or showed intestinal metaplasia alone. Our findings suggest that Cytosponge should be integrated as an adjunct in Barrett’s surveillance, with clear benefits in safer and accurate monitoring of the condition without the risks of endoscopy.