bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P38 The impact of hospital experience in bariatric surgery on short-term outcomes after minimally invasive oesophagectomy: a nationwide analysis
Authors: Janssen Henricus , Geraerdts Tessa , Simkens Geert , Visser Maurits , de Hingh Ignace , van Det Marc , Nieuwenhuijzen Grard , van Hillegersberg Richard , Luyer Misha , Nienhuijs Simon 
Published: November 2023

Abstract

Background
Minimally invasive oesophagectomy (MIO) is a technically challenging procedure with a substantial learning curve. Composite volume of upper gastrointestinal (upper GI) procedures for cancer has been previously linked to postoperative outcomes. This study aimed to investigate an association between hospital experience in bariatric surgery and short-term outcomes in MIO.

Methods
Data on oesophagectomy patients between 2016 and 2020 were collected from the Dutch Upper Gastrointestinal Cancer Audit, a mandatory nationwide registry. Hospitals were categorized as bariatric or non-bariatric. Dutch institutions have a mandatory annual threshold of 200 bariatric and 20 oesophagectomy procedures. Multivariable logistic regression investigated short-term postoperative outcomes, adjusting for case-mix.

Results
Of 3371 patients undergoing oesophagectomy in sixteen hospitals, 2450 (72.7%) underwent MIO. Bariatric hospitals (N=6) accounted for 1057 (43.1%) MIO. Overall postoperative complication rate was lower in bariatric hospitals (59.2% vs. 65.9%, P&lt;0.001). Bariatric hospitals were associated with a reduced risk of overall complications (OR 0.72 [95%CI 0.60-0.87]), length of hospital (OR 0.73 [95%CI 0.61-0.87]) and ICU stay (OR 0.83 [95%CI 0.69-1.00] (P=0.046)) after MIO. Surgical radicality did not differ. Lymph node yield (≥15) was lower in bariatric hospitals (90.0% vs. 94.7%, P&lt;0.001). Several short-term outcomes showed a significantly improving trend over the years in bariatric, but not non-bariatric hospitals.

Conclusions
In this nationwide analysis, bariatric hospitals were associated with improved short-term outcomes after MIO and further improved over the years. Characteristics of bariatric hospitals that could explain this phenomenon and whether this translates to other upper GI procedures may be warranted to identify.
OGC P39 The accuracy of Hospital Acquired Pneumonia (HAP) Diagnosis after Oesophagectomy
Authors: Waheed Unaiza , Alvi Quraishi Rumaysa , Patel Minal , Worthington Lucy , Fidler David , Heal Calvin , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Oesophagectomy is a high-risk intervention associated with significant rates of morbidity. Pneumonia is a complex spectrum of infective and non-infective aetiology, varying in severity and is common after oesophagectomy. Inconsistent definitions of pulmonary complications pose significant challenges in both the clinical and research setting. The internal Esophageal Consensus Complications Group (ECCG) have adopted the Centre for Disease Control (CDC) criteria for HAP diagnosis to address this. However, other validated diagnostic criteria are also available. This study aimed to better understand the incidence of HAP after oesophagectomy, and the accuracy of four validated diagnostic tools.

Methods
This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG centre serving a population of 3.5 million patients between 2014-2022. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. The timing of pneumonia diagnosis was determined in the post-operative period, alongside observations and Computed Tomography (CT) and Chest X-Ray (CXR) reports. Four diagnostic criteria (Centres for Disease control- CDC, American Thoracic Society - ATS, Utrecht and Clinical Pulmonary Infection Score - CPIS) were applied to determine the incidence of HAP in comparison to patients treated for HAP. Statistical tests were performed in STATA.

Results
460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP between 2014-2022. 56 (12.2%) met the CDC criteria. Mean days to diagnosis was 5 days (SD +/- 3.72). Diagnostic sensitivity and specificity for HAP was 88.89%, and 50.15% respectively. The ATS criteria were met by 79 patients (17.2%), showing a similar sensitivity (97.53%) and specificity (92.02%) to the CDC criteria. The Utrecht criteria had the lowest specificity (75.20%) for HAP diagnosis. 192 patients had sputum samples; 158 (82.29%) were culture positive. 52 patients were re-intubated, of which 29 (55.8%) were reintubated due to respiratory failure.

Conclusions
HAP is a complex and nuanced diagnosis with high inter-observer variation. Currently available and validated diagnostic tools result in different rates of HAP diagnosis. These findings highlight the importance of adopting robust approaches to diagnosing HAP to avoid unnecessary treatments and to more accurately determine the effectiveness of protocolised management (such as ERAS) that target HAP. The findings also highlight important implications on outcome reporting in research, particularly with interventions (e.g. minimally invasive and robotic surgery) which aim to reduce the burden of post-operative morbidity. Further widescale studies are required to validate these findings.
OGC P43 Is surgery (gastrectomy) alone more effective than surgery combined with adjuvant chemotherapy for the treatment of Stage I-III gastric adenocarcinoma?
Authors: Kaur Rikhraj Naveena 
Published: November 2023

Abstract

Background
Gastric adenocarcinoma, the malignant proliferation of glandular cells in stomach epithelium, is a type of gastric cancer with statistical disease-burden of the 5th most common global and 17th most common cancer in the UK. Gastric adenocarcinoma at different stages (Stage I-IV) present with different prognoses. Particularly promising subset is patients with Stage I-III gastric adenocarcinoma, presenting with 5-year survival rates up to 71.8%, warranting early diagnosis and effective treatment can be vital. There are several treatment modalities, currently surgery being gold-standard. However, understanding pathological nature of tumour development, combination treatments, such as adjuvant chemotherapy after surgery can maximise patient outcomes.

Methods
The study aimed to investigate patients with Stage I-III (non-advanced) gastric adenocarcinoma, in understanding whether adjuvant chemotherapy combined with surgery provides (1) greater disease-free/disease-specific/cause-specific survival, (2) overall survival, (3) decreased recurrence rates or improved recurrence-free survival, compared to surgery alone.
17 (3 randomised-control, 10 cohort, 4 case-control) English-language, full-text, Level I-III, peer-reviewed studies from MEDLINE and Embase databases, in past 10 years were reviewed. No age/sex/ethnicity/country restrictions applied and dimension of interest limited to Stage I-III gastric adenocarcinoma patients who had undergone tumour resection via surgery, and received chemotherapy as the only adjuvant therapy.

Results
7/17 (41.2%) of studies have at least one statistical outcome measure (DFS/OS/RFS, measured by p-values and HR/OR) that supports, with statistical significance, that adjuvant chemotherapy combined with surgery has benefit over surgery alone for the treatment of Stage I-III gastric adenocarcinoma. Majority of studies, 10/17 (58.8%) do not show statistically significant benefit of adjuvant chemotherapy.

Conclusions
In conclusion, findings of this study are limited by sample size and bias present in individual studies reviewed. Thus, findings are different when compared to prior large-scale meta-analyses and ongoing research is needed in the field (with consideration to advances in interventions i.e. surgical technique and new chemotherapeutic combinations) to fully understand whether adjuvant chemotherapy is effective when combined with surgery for treatment of gastric adenocarcinoma.
OGC P50 Evaluating the outcomes of routine level one ward care post major oesphago-gastric surgery
Authors: Johnson Courtney , Walmsley James , Berrisford Richard , Chan David S Y , Humphreys Lee , Sanders Grant , Wheatley Tim , Ariyarathenam Arun 
Published: November 2023

Abstract

Background
Oesophago-gastric cancer resections are complex operations. Many centres routinely manage patients in higher acuity settings such as surgical HDU, ITU or fast track beds.
The UK has 2.4 critical care beds per 1000, compared to an average of 5 per 1000 across OECD-EU nations. The COVID-19 pandemic has also had a significant impact on availability of these beds.
Patients in our unit are routinely admitted to a standard level one surgical bed with continuous non-invasive cardiac monitoring and nursing care ratio of 1 to 5. This has been in practice for over 10 years with good outcomes.

Methods
Consecutive major oesophago-gastric resections between April 2020 and March 2023 in a single tertiary unit were included.
Patients were split into two groups:
Patients who were admitted directly to the surgical ward or had a planned admission to ITU based on pre-operative assessment and routine Integrated Cardiopulmonary Exercise Testing (CPEX) outcomes were considered to have completed a standard pathway.
The primary outcome was unplanned ITU admission rate. Secondary outcomes included: total length of stay (TLOS), 30- and 90-day mortality.

Results
238 patients (187 M: 51 F) were identified with a median age of 69 (33 – 84 years).
The resections performed were Ivor Lewis oesophago-gastrectomy (ILGO) (n=196, 81%), total/extended total (n=30), subtotal (n=10) or distal gastrectomy (n=3). 34 patients were admitted to ITU, of which 23 were unplanned (9.2%) and all had undergone an ILGO. The median TLOS and mortality data are outlined in Table 1, with &lt;1% 30 and 90-day mortality for patients on the standard pathway.
The median ITU length of stay was 5 days (1 – 48 days) with reasons for admission listed in Table 2.

Conclusions
Major oesophago-gastric cancer resections can be managed safely in the early post-operative period, outside of higher acuity care settings with good outcomes.
OGC P56 Preliminary results from the use of a symptom response questionnaire following pyloric dilatation for delayed gastric emptying post-oesophagectomy
Authors: Chevallay Mickael , Barman Sowrav , Evans Orla , Taylor Joanna , Dunn Jason , Baker Cara , Kelly Mark , Knight William , Gossage James , Zeki Sebastian , Davies Andrew 
Published: November 2023

Abstract

Background
Patient symptom burden following oesophago-gastrectomy is high with numerous potential underlying causes which can often overlap. Diagnostic test results and the symptom response to a given intervention may provide important insights, yet there are no validated questionnaires to support the latter. Delayed gastric emptying is a common problem after oesophagectomy, significantly affecting patients' quality of life. The most common treatment option is to perform an endoscopic pyloric dilatation. However, there is no tool available to measure its effect on patient's quality of life. We have developed a symptom response questionnaire to evaluate the impact of the pyloric dilatation procedure.

Methods
With patient involvement, a symptom response to treatment questionnaire was developed based on validated EORTC symptom questions. Although designed to assess symptom response to any intervention, consecutive patients referred for suspected delayed gastric emptying who received an endoscopic pyloric dilatation from a single center were included in this study. Patients were contacted by telephone at two and four weeks after the procedure to complete the symptom response questionnaire. The investigators contacting the patients were neither their surgeon nor the one who performed the endoscopic procedure. We excluded all patients receiving other endoscopic treatment than a pyloric dilatation.

Results
27 patients responded to the questionnaire at 2 and 4 weeks. The main reported symptoms were dysphagia in 15 patients (58%) and reflux in 6 patients (21%). An improvement in symptom frequency was noted in 23 patients (85%) at two weeks. A subsequent worsening in the patient symptom frequency was noted in 3 patients (8.8%) between two and four weeks. Regarding the severity of the symptom, an improvement was observed in 24 out of 27 patients (88%) after two weeks, and no patients reported a worsening of symptom severity at the four-weeks call.

Conclusions
The symptom response questionnaire aimed at evaluating the impact of pyloric dilatation was easily implemented and well-received by the patients for completion. By providing a structured and patient-centred approach, this questionnaire can serve as a basis for monitoring and understanding the effectiveness of endoscopic interventions in improving the quality of life for patients with delayed gastric emptying. An electronic version of the questionnaire has been developed and will be tested in the near future.
OGC P60 Impact of deprivation on treatment of oesophageal squamous cell carcinoma across a regional cancer network
Authors: Wholey Joshua , Owen Richard , Ogle Harriet , Day Georgina 
Published: November 2023

Abstract

Background
Oesophageal cancer accounts for 8000 deaths per year in the United Kingdom, and 400,000 deaths globally. There are two main histological subtypes: oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC), with the former accounting for 90% of cases. Oesophageal cancer, particularly OSCC displays a strong correlation with deprivation, with females and males in the most deprived quintile having a corresponding 43% and 50% higher incidence rate compared to the least deprived. This study aims to look at whether deprivation across a regional network also affects treatment choice offered to patients, primarily definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy.

Methods
A total of 76 patients diagnosed with oesophageal squamous cell carcinoma were identified from the regional cancer network database from 2016 to 2019. Patients were ranked into 10 deprivation quintiles using the English indices of deprivation 2019 (IoD2019). Patients were subdivided into two groups based on treatment modality, definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy with a plan for surgery (nCRT). Statistical analysis was performed using R-statistical software with logistical regression and T-tests performed.

Results
A total of 76 patients were included in the final data set with 52 patients receiving dCRT and 24 receiving nCRT. Deprivation was associated with a statistically significant impact on treatment choice, with patients in higher deprivation quintiles more likely to be offered nCRT (logOR 0.40, 95%CI 0.11-0.75) p-value 0.013. Other important factors were gender, with male patients more likely to be offered dCRT (LogOR -1.8, 95%CI -3.7- -0.30) p-value 0.030. Important cofounders were cancer staging and gender with the dCRT group having a higher number of stage 4 cancers and males compared to the nCRT group.

Conclusions
In conclusion, deprivation had a statistically significant impact on treatment modality of OSCC, with patients in higher deprivation quintiles more likely to be offered nCRT. However, there are important confounders to take into consideration, particularly cancer staging and gender which may explain the results.
OGC P62 Preoperative IVC filter insertion for oesophagogastric cancer surgery patients
Authors: Yee Kuan Jen , Yie Liew Yong , Van Staa Syamsundar , Ahmed Salman , Singh Mohan , Turner Paul , Pursnani Kishore , Ward Jeremy , Ball Christopher , Daya Shetty Vinutha 
Published: November 2023

Abstract

Background
Venous thromboembolism (VTE) is a life-threatening complication in cancer patients undergoing oesophagogastric surgery. Oesophagogastric cancer patients are at high risk of developing perioperative VTE due to neoadjuvant chemotherapy, prolonged immobilisation, reduced oral intake, and increased risk of dehydration. NICE guideline [NG158] recommends considering an inferior vena cava (IVC) filter for patients with proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) when anticoagulation treatment is contraindicated. This study evaluates the effectiveness and safety of preventing perioperative VTE recurrence via the preoperative insertion of the IVC filter after adopting this as a trust-wide policy in 2012.

Methods
This is a 10-year retrospective study from July 2012-2022. All patients who underwent cardio-oesophagectomy or gastrectomy for oesophagogastric cancers were included. All patients who underwent benign oesophagogastric surgery or local excision of GIST were excluded. The primary outcome includes the incidence of perioperative VTE recurrence following preoperative insertion of an IVC filter. The secondary outcome includes the inpatient and 30-day complications and mortality following the insertion of the IVC filter.

Results
582 patients were included in our study. 37/582 (6.4%) patients developed preoperative VTE, in which 25/37 (67.6%) patients were diagnosed with PE, whereas 12/37 (32.4%) patients had proximal DVT. 30/37 (81.1%) patients underwent preoperative IVC filter insertion, while 7/37 (18.9%) did not. Of these 7 patients, 1 patient developed popliteal DVT 9 months after surgery. There was a statistically significant difference in preventing perioperative VTE recurrence through IVC filter insertion before surgery (p&lt;0.05). IVC filters were safely removed in all patients postoperatively. No inpatient or postprocedural 30-day complications or mortality was identified.

Conclusions
This study has demonstrated that preoperative IVC filter insertion could prevent perioperative VTE recurrence in cancer patients who underwent oesophagogastric surgery. However, the retrospective nature of this study and the relatively small sample size are the main limitations. Preoperative IVC filter insertion is deemed safe, given no postprocedural morbidity or complications were identified.
OGC V01 Robotic salvage oesophagectomy and extended thoraxic lymphadenectomy
Authors: Joel Abraham , Cross Andrea , Brown Joshua , Aradaib Mohammed , Wahed Shajahan , Immanuel Arul 
Published: November 2023

Abstract

Background
One of the options for treating oesophageal squamous cell cancer (SCC) is with definitive chemoradiotherapy, rather than surgery. Although small in number, a subset of these patients develop local recurrence without distant metastases and have no other curative intent treatment option but salvage esophagectomy. However, salvage esophagectomy is associated with high rates of morbidity and mortality, but can offer long-term survival. We demonstrate a case of robotic salvage oesophagectomy, performed in a high volume UK centre.

Methods
We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 68 year old male patient with a BMI of 24 and performance status of 0, underwent robotic salvage Oesophagectomy for mid oesophageal SCC. Patient was initially treated with definitive chemoradiotherapy, however developed local recurrence, without distant metastasis. Preoperatively staging investigations included endoscopy, endoscopic ultrasound, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET). PET identified an avid node in the tracho-oesophageal groove.

Results
Patient was on the high dependency unit as per the units routine practice for less than 24 hours and was transferred to our monitored bed on the ward. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged after 10 days.

Conclusions
We demonstrate a safe robotic technique for performing salvage Oesophagectomy in patients who have previously had chemoradiotherapy.
OGC V03 Video Guide to Performing Robotic Oesophago-Gastric Anastomosis
Authors: Walmsley James , Sanders Grant , Chan David S Y 
Published: November 2023

Abstract

Background
The aim of this video is to present our technique for performing a robotic semi-mechanical oesophago-gastric anastomosis.

Methods
The four-minute video was edited from a recording of a 2-stage robotic Ivor Lewis procedure for gastro-oesophageal junction cancer. The thoracic stage shown was performed using the Da-Vinci Xi system. The video focuses on demonstrating our standard semi-mechanical robotic anastomosis. We highlight the techniques involved in ensuring satisfactory join length and placement. Relevant regional anatomy and landmarks are highlighted.

Results
Post procedure the patient was transferred to a level one ward bed. They had an uneventful recovery following our standard enhanced recovery post-oesophagectomy protocol. The patient was discharged on day 7.

Conclusions
This video provides a clear guide to performing our technique for a robotic Oesophago-Gastric anastomosis. It is a useful resource for new robotic and trainee surgeons.
Stuttering associated with a pathogenic variant in the chaperone protein cyclophilin 40
Authors: Morgan Angela T , Scerri Thomas S , Vogel Adam P , Reid Christopher A , Quach Mara , Jackson Victoria E , McKenzie Chaseley , Burrows Emma L , Bennett Mark F , Turner Samantha J , Reilly Sheena , Horton Sarah E , Block Susan , Kefalianos Elaina , Frigerio-Domingues Carlos , Sainz Eduardo , Rigbye Kristin A , Featherby Travis J , Richards Kay L , Kueh Andrew , Herold Marco J , Corbett Mark A , Gecz Jozef , Helbig Ingo , Thompson-Lake Daisy G Y , Liégeois Frédérique J , Morell Robert J , Hung Andrew , Drayna Dennis , Scheffer Ingrid E , Wright David K , Bahlo Melanie , Hildebrand Michael S 
Published: November 2023

Abstract
Stuttering is a common speech disorder that interrupts speech fluency and tends to cluster in families. Typically, stuttering is characterized by speech sounds, words or syllables which may be repeated or prolonged and speech that may be further interrupted by hesitations or ‘blocks’. Rare variants in a small number of genes encoding lysosomal pathway proteins have been linked to stuttering. We studied a large four-generation family in which persistent stuttering was inherited in an autosomal dominant manner with disruption of the cortico-basal-ganglia-thalamo-cortical network found on imaging. Exome sequencing of three affected family members revealed the PPID c.808C&gt;T (p.Pro270Ser) variant that segregated with stuttering in the family. We generated a Ppid p.Pro270Ser knock-in mouse model and performed ex vivo imaging to assess for brain changes. Diffusion-weighted MRI in the mouse revealed significant microstructural changes in the left corticospinal tract, as previously implicated in stuttering. Quantitative susceptibility mapping also detected changes in cortico-striatal-thalamo-cortical loop tissue composition, consistent with findings in affected family members. This is the first report to implicate a chaperone protein in the pathogenesis of stuttering. The humanized Ppid murine model recapitulates network findings observed in affected family members.