bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN V02 Robotic common bile duct clearance
Authors: Stefanova Irena , Pencavel Timothy , Lahiri Rajiv 
Published: November 2023

Abstract

Background
A 44-yar old male patient presented with painful obstructive jaundice and bilirubin of 127 μmol/L. A Contrast Enhanced Computed Tomography (CECT) revealed dilated biliary tree as a result of obstructing stone in the proximal common bile duct (CBD). The patient underwent an Endoscopic Retrograde CholangioPancreatography (ERCP) and sphincterotomy which demonstrated pus in the bile duct, but also a stone impacted in the common hepatic duct which could not be extracted endoscopically. Therefore, a 7Fr pigtail stent was inserted. Subsequently, he was discharged home and re-admitted for an elective robotic cholecystectomy and bile duct clearance 6 weeks later.

Methods
Robotic CBD clearance was performed using DaVinciXi system, a 12mm Airseal and four 8mm robotic ports. The patient was supine with split legs(15 degrees), in reverse Trendelenburg position and left tilt. The CBD was dissected out, the anterior duct wall was delineated and longitudinal choledochotomy was carried out. A large stone was extracted through the choledochotomy site followed by removal of stent. Subsequently, a cholangioscopy was performed using a single-use flexible ureteroscope and no further stone disease was identified proximally or distally. Following this, a bile duct closure was performed using 4-0 Polydioxanone interrupted sutures and SutureCut Needle Driver.

Results
There were no intra- or post-operative complications. The patient made an excellent recovery from robotic common bile duct clearance and was discharged home less than 24 hours post procedure.

Conclusions
This video presentation highlights the technical aspects of robotic common bile duct clearance and demonstrates that the robotic system allows for accurate dissection and precise suturing which could reduce the risk of bile duct stricture.
OGBN V03 Robotic choledochoduodenostomy for benign common bile duct stricture
Authors: Stefanova Irena , Iosif Evangelia , Pencavel Timothy , Lahiri Rajiv 
Published: November 2023

Abstract

Background
A 54-year-old male patient was referred with benign distal common bile duct (CBD) stricture secondary to chronic pancreatitis. He had multiple admissions with recurrent cholangitis requiring numerous Endoscopic Retrograde CholangioPancreatographies (ERCPs) and stent exchanges including SpyGlass procedure which did not demonstrate evidence of malignancy. His quality of life was poor due to debilitating pain and recurrent hospital admissions so he was offered elective choldechoduodenostomy aiming to bypass the bile duct stricture, but also allowing continued endoscopic surveillance.

Methods
A robotic choledochoduodenostomy was performed using the DaVinciXi system, a 12mm Airseal and four 8mm robotic ports. The patient was supine with split legs(15degrees) in reverse Trendelenburg position with a slight left tilt. Initially, robotic cholecystectomy was carried out following which the CBD was dissected and its anterior wall delineated. The duodenum was kocherised to allow sufficient mobility for anastomosis. Subsequently, a longitudinal choledochotomy was performed and a metal stent was extracted. Then, an enterotomy was made perpendicularly to the choledochotomy. A choledochoduodenostomy was performed using continuous 4-0-V-Loc sutures for posterior wall and 4-0-PDS continuous sutures for anterior wall.

Results
The post-operative period was uncomplicated. The patient experienced minimal pain after procedure and was discharged home on post-operative day 2. He was reviewed in outpatient clinic 6 weeks after, and reported he had successfully discontinued all regular opiates and benzodiazepines previously used for pain control.

Conclusions
A robotic choledochoduodenostomy is an excellent alternative for the treatment of benign bile duct strictures in patients with recurrent cholangitis requiring repeated stent exchanges. Moreover, it has the advantage of continued endoscopic surveillance which is not possible with traditional hepatico-jejunostomy.
HPB P05 PET-CT in the staging of potentially resectable pancreatic cancer
Authors: Al Saoudi Tareq , Chawla Kanika , Sarwar Dawud , Isherwood John , Bhardwaj Neil , Dennison Ashley , Garcea Giuseppe 
Published: November 2023

Abstract

Background
Pancreatic adenocarcinoma (PDAC) presents a significant global health challenge particularly as it is generally diagnosed at an advanced stage. Although cross-sectional imaging techniques including multidetector CT (MDCT) are familiar and ubiquitously used the role and value of PET-CT scans in PDAC management remains unclear.

Methods
This six-year study analysed patients who underwent PET-CT scans for suspected PDAC. Demographics, cross-sectional imaging and PET-CT results, management decisions, and histology were collected together with rates of operation with curative intent and the time interval between scans and surgical intervention.

Results
Of 161 patients, 110 were operable, but 51 weren't. Among operable ones, 20 had extra-pancreatic lesions; 90 didn't. Without extra-pancreatic lesions, 68 underwent surgery, 12 unfit, and 10 had benign conditions. Among those explored, 9 had unconfirmed suspected metastasis. Of all explored, 48 had successful resection; 20 had precluding diseases. In the subset with extra-pancreatic lesions, 4 were inoperable due to confirmed metastasis. The remaining 16 explored had equivocal or unrelated lesions; 9 were resectable, 7 weren't. PET-CT scans impacted patient management in 8% of cases.

Conclusions
PET-CT scans play a crucial role in the management of suspected PDAC, but routine use may not be justified. Further research is needed to identify the subset of patients who benefit most. Clear guidelines for PET scan utilization in clinical practice are required to optimize the role in PDAC management.
HPB P10 The impact of an electronic referral system for tertiary pancreatitis referrals
Authors: Huntly Benjamin , Kerrison Hannah , Smith Andrew , Pathak Samir , Young Alistair , Shapey Iestyn , Pine James 
Published: November 2023

Abstract

Background
In the Leeds catchment, pancreatitis referrals were made ad hoc via telephone or email. This was frequently by a junior team member and essential information was frequently absent. Frustratingly the referring teams did not know who to contact and often had to make multiple calls. There was no record of these referrals and the advice provided. As a Quality Improvement we instituted an electronic referral system.

Methods
An Electronic referral system (Patient Pass, already within the Trust) was utilised. We developed a simple questionnaire for the referrer to complete. This was accessed via a hyperlink on the Leeds Pancreas Unit website. Images could be reviewed using a regional El Xero server without the need for image transfer This was implemented in September 2021.
The system is monitored Monday to Friday by either an Advanced Clinical Practitioner or by the senior registrar/fellow. Information and scans are reviewed, and all cases discussed with the on call pancreas consultant. A survey was sent to all users in secondary care.

Results
166 referrals in 21 months , Average response time from initial referral was under 3 hours. 46/166 transferred to LTHT. Average number of responses per individual referral. Overall satisfaction was over 80% from secondary care. The Pancreas team has found it easier to provide timely accurate advice on a complete set of data, especially the immediate access to images.

Conclusions
An electronic referral system has led to increased satisfaction for referrers. The system has led to an open, auditable, visible, referral and advice process. This has allowed patients to remain in the local hospital closer to home and visitors until the time intervention is needed or appropriate.
HPB P12 Do Chemotherapy Factors or Treatment Intervals Influence Pathological Tumour Response during Neoadjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma? A Bi-Institutional Study
Authors: Halle-Smith James , Leung Prudence , Hall Lewis , Askin Merve , van Laarhoven Stijn , Skipworth James , Brown Rachel , Roberts Keith 
Published: November 2023

Abstract

Background
Pathological response of pancreatic ductal adenocarcinoma (PDAC) to neoadjuvant chemotherapy (NAT) can be assessed using grading systems such as the College of American Pathologists (CAP) system, with favourable regression being associated with improved oncological outcomes. The aim of the study was to investigate factors associated with favourable tumour regression in patients undergoing pancreatoduodenectomy (PD) for PDAC.

Methods
Patients who received NAT before undergoing PDAC resection at two institutions in the United Kingdom between 2013 and 2021 were reviewed. Interactions between chemotherapy regimens, tumour staging, carbohydrate antigen 19-9 (Ca19-9) levels, perioperative factors and tumour regression grading (TRG) were explored.

Results
54 patients were identified who were suitable for inclusion. 12 (22%) patients had a favourable response to NAT according to the CAP grading system. A significantly greater reduction in Ca19-9 observed in the favourable TRG group [mean -2359 U/mL] compared to the unfavourable TRG group [mean -569 U/mL (p&lt;0.001). The type of chemotherapy agent received, the number of cycles or whether the patient had a dose reduction during their NAT course did not differ significantly between the groups. The time from diagnosis to chemotherapy and time from end of chemotherapy to surgery were also similar between the groups.

Conclusions
In this bi-institutional retrospective study, neither chemotherapy factors nor treatment intervals were not found to be significantly related to pathological tumour response to NAT in PDAC patients undergoing resection. Given that a favourable pathological response has been related to improved oncological outcomes, future research should concentrate on further mechanisms that may influence the response of PDAC tumours to NAT, such as gene expression and the tumour microbiome. Given that NAT is also a relatively new approach, further multicentre collaboration should be encouraged to increase numbers of patients for study.
HPB P14 Setting the Foundation: Empowering Junior Doctors in Complex Specialties through Induction Excellence
Authors: Al Saoudi Tareq , Chawla Kanika , Pollard Cris , Isherwood John , Bhardwaj Neil , Garcea Giuseppe , Dennison Ashley 
Published: November 2023

Abstract

Background
The newly qualified junior doctors in the UK face challenges due to limited experience and unfamiliarity with their rotations. We aim to share the experience of establishing a Hepatobiliary and Pancreatic (HPB) surgery specific induction program at University Hospitals of Leicester NHS Trust and assess its impact on doctors' knowledge and experience.

Methods
A booklet was distributed to new junior doctors and a two-hour structured teaching session was also conducted, with pre- and post-session assessments using multiple-choice questions and a feedback survey. The survey measured understanding of HPB anatomy, interventions, and satisfaction with the teaching methodology.

Results
Prior to the teaching session, levels 4 and 5 understanding of HPB anatomy were reported by 18.1% of participants. After the teaching session, there was a significant improvement in understanding, with levels 4 and 5 reported by 95% of participants, and only 5% reporting level 3. Similar improvements were observed in other tested categories. Factual knowledge also improved, with a 38% increase in correct responses on basic HPB and surgical knowledge questions. Participants found the session helpful and well-structured, with 60% strongly agreeing and an additional 30% agreeing. The delivery method was deemed appropriate by the majority.

Conclusions
Specialty-specific induction programs are crucial for providing support and ensuring the development of competent doctors. Efforts should be made to create supportive working environments for junior doctors to alleviate stress and improve their well-being.
HPB P16 How relevant are additional histological features when predicting five-year recurrence/survival rates afterpancreatoduodenectomy for ampullary adenocarcinoma? Results from the Recurrence After Whipple’s (RAW) study
Authors: Hall Thomas , Kahar Nurul , Nadeem Nabeegh , Shah Nehal 
Published: November 2023

Abstract

Background
Providing they have an appropriate performance status, patients with ampullary adenocarcinoma (AA) may be offered pancreatoduodenectomy (PD) with curative intent. Aggressive histological tumour characteristics are known to correlate with poor long-term outcomes. This study aimed to quantify how peripancreatic fact invasion (PPFI), perineural invasion (PNI), microvascular invasion (MVI) and lymphatic invasion (LI) correlate with five-year recurrence and five-year survivalrates.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Patients with histologically confirmed AA were identified and compared by their PPFI, PNI, MVI and LI statuses. Fisher’s exact test was used for the comparisons.

Results
A total of 394 patients (26.5%) had AA confirmed. Incidence rates of PPFI, PNI, MVI and LI were 37.8%, 46.1%, 45.2% and 58.6%, respectively. Five-year recurrence was significantly higher in patients demonstrating PPFI (58.9% vs 34.3%, p=0.0005), PNI (56.6% vs 34.0%, p=0.0001), MVI (60.2% vs 34.2%, p&lt;0.0001) and LI (54.7% vs29.2%, p&lt;0.00001). Five-year survival was significantly lower in patients with PPFI (29.4% vs 62.9%, p&lt;0.0001), PNI (40.4% vs 64.8%, p&lt;0.0001), MVI (43.0% vs 61.3%, p=0.003) and LI (44.1% vs 65.0%, p&lt;0.0005). Patients with PPFI, PNI, MVI and LI were significantly more likely to have histological T3-4 disease (vsT1-2, all p&lt;0.0001).

Conclusions
In our multicentre study of AA patients who underwent PD, less than half had histological evidence of PPFI, PNI or MVI, but a majority had LI. All of these features were associated with increased recurrence and reduced survival rates. However, this likely reflects the fact that these features all correlate with more advanced histological disease.
HPB P18 Continuous drain irrigation as a risk mitigation strategy for postoperative pancreatic fistula; a meta-analysis
Authors: Llwyd Hughes Daniel , Hughes Aron , Gordon-Weeks Alex , Silva Michael 
Published: November 2023

Abstract

Background
Postoperative Pancreatic Fistula (POPF) formation serves as the principle cause for the significant morbidity and mortality rates observed following pancreatectomy. Several different POPF mitigation strategies have been previously trialled, with variable success. Continuous drain irrigation as a treatment strategy for infected pancreatic necrosis has previously been described as an effective treatment strategy, however its role following pancreatectomy has yet to be determined.

Methods
A meta-analysis of the pre-existing literature was performed. The primary endpoint was determining whether continuous drain irrigation reduced POPF rates following pancreatectomy. Secondary endpoint evaluated its impact on post operative morbidity, mortality and length of stay. Analysis of dichotomous variables (complication rates) was calculated utilising the odds ratio (OR) with 95% confidence interval (CI) with the Mantel–Haenszel method with a random effects model. Continuous data (length of stay) was assessed using mean difference (MD) and 95% CI with the inverse variance random effects model. Data was tabulated and visualised through the creation of forest plots.

Results
Nine articles involving 782 patients was included in this meta-analysis. Continuous drain irrigation use was associated with a statistically significant reduction in POPF rates (OR (95% CI) 0.40 (0.19-0.82), p=0.01). Upon subgroup analysis, a significant reduction in clinically relevant POPF was also noted (OR 0.37 (0.20-0.66), p = 0.0008). A reduction in post operative complications was also observed: delayed gastric emptying (0.45 (0.24-0.84), p = 0.01) and the need for re-operation (0.33 (0.11-0.96), p = 0.04). This reduction in post operative complications rates also translated into a reduced post operative length of stay (MD -2.62 (-4.97 - -0.26), p =0.03).

Conclusions
Continuous drain irrigation following pancreatectomy serves as an effective risk mitigation strategy against POPF.
HPB P19 Post-hepatectomy liver failure: A timeline centered review
Authors: Bekheit Mohamed , Grundy Lisa , Salih Ahmed K A , Bucur Petru , Vibert Eric , Ghazanfar Mudassar 
Published: November 2023

Abstract

Background
Post-hepatectomy liver failure (PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. Whilst the literature addressing PHLF appears ubiquitous, there is no specific structure that summarizes the evidence that can guide surgeons regarding the timeline of the preventive measures against PHLF. The objective of this review is to summarize the published measures and their sources of evidence, in a timeline centered way around the index (i.e., definitive) hepatectomy, thus, summarizing the practice in prediction, prevention, and treatment.

Methods
This review includes studies on both humans and animals, where they addressed PHLF. A literature search was conducted across the Cochrane Library, Embase, MEDLINE/PubMed, and Web of Knowledge electronic databases for English language studies published between July 1997 and June 2020. Studies presented in other languages were equally considered. The quality of included publications was assessed using Downs and Black’s checklist. The results were presented in qualitative summaries owing to the lack of studies qualifying for quantitative analysis.

Results
This systematic review with 245 studies, provides insight into the current prediction, prevention, diagnosis, and management options for PHLF. This review highlighted that liver volume manipulation is the most frequently studied preventive measure against PHLF in clinical practice, with modest improvement in the treatment strategies over the past decade.

Conclusions
Remnant liver volume manipulation is the most consistent preventive measure against PHLF.
HPB P20 Radical Single Stage Liver Resection of Bilobar Colorectal Liver Metastases
Authors: Patel Pranav , Doyle Joseph , Yeung Derek , Patel Nikhil , Kumar Sacheen , Bhogal Ricky 
Published: November 2023

Abstract

Background
Surgical resection of Colorectal Liver Metastases (CRLM) offers the best long-term patient survival with current 5-year survival rates of 50%. However, bilobar CRLM often require an individualised patient approach with the primary goals being oncological resection of metastases and adequate future liver remnant. A number of surgical approaches can be used for bilobar CRLM including resection ± ablation, two stage hepatectomy ± portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy (ALPSS), or extended hepatectomy. We describe our approach of single stage parenchymal preserving (SSPP) liver resection for bilobar CRLM.

Methods
All patients with bilobar CRLM that underwent liver resection in a single, tertiary, specialist cancer centre in the UK between April 2018 to December 2021 were included. All liver resections were carried out using an open approach and 6-8 weeks after the cessation of chemotherapy. Pringle was used in all patients. We assessed peri-operative and oncological outcomes as well as disease-free (DFS) and overall (OS) patient survival.

Results
A total of n=42 patients underwent SSPP surgery during the study period. Median age was 54 years (range 36-71) and 93% were performance status=0. Pre-operative chemotherapy was administered in n=39 patients. A median of 4 lesions were resected (range 3-12). Median blood loss was 450mls (range 115-2500mls). R0 resection rate was 95%, with no post-operative liver failure and no peri-operative mortality. Bile leak rate was 10% and n=1 required massive blood transfusion. Median DFS was 13 months, and n=26 patients recurred by the end of the study period. Of these, n=14 were suitable for further treatment. Five-year OS was 77%.

Conclusions
SSPP liver resection for bilobar CRLM is associated with low peri-operative complications and good oncological outcomes. Early recurrence is noted but patients remain eligible for further liver- directed therapies or systemic treatment allowing for good overall patient survival.
HPB P21 A Systematic review and Narrative Synthesis of Health Economic Evaluation of single use duodenoscopes
Authors: Elnour Abdolazeem , Subramanian Kumaresh , YKS Viswanath 
Published: November 2023

Abstract

Background
Multidrug-resistant infections transmitted through duodenoscopes in ERCP procedures have raised significant concerns. In response, the U.S. Food and Drug Administration (FDA) has suggested shifting from traditional reusable duodenoscopes to newer, more innovative designs. These new models, including completely disposable duodenoscopes and those with disposable endcaps, aim to enhance cleaning efficiency and reduce infection risks. While sterile, single-use duodenoscopes have been a breakthrough in eliminating cross-infections, their adoption poses cost-related challenges.

Methods
We conducted a systematic literature search across various databases for studies that examined the cost-effectiveness of these two types of duodenoscopes. Four studies met our inclusion criteria, involving diverse settings and study designs, including cost-effectiveness, cost-utility, and cost-minimization analyses.

Results
All four studies suggested that single use duodenoscopes could be cost-effective compared to reusable ones under certain circumstances, such as specific infection rates, procedure volumes, and willingness to pay thresholds. However, limitations in the generalizability of findings were noted, and the quality of evidence varied across studies.

Conclusions
Current evidence indicates potential cost-effectiveness for single-use duodenoscopes, although it is context-dependent. More robust, high-quality studies are needed to confirm these findings and further explore the cost-effectiveness in various clinical settings and scenarios. The potential environmental impact of single use duodenoscopes warrants further exploration.